Healthcare Provider Details

I. General information

NPI: 1609153469
Provider Name (Legal Business Name): KRISTEN KALEEN MOKE MA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 8TH ST NE
WASHINGTON DC
20002-5227
US

IV. Provider business mailing address

2301 COLUMBIA PIKE APT 125
ARLINGTON VA
22204-4453
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-5439
  • Fax: 202-379-1797
Mailing address:
  • Phone: 571-527-0818
  • Fax: 202-379-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119006139
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010001277
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: