Healthcare Provider Details

I. General information

NPI: 1922633635
Provider Name (Legal Business Name): GRACE ANNABEL KELSO OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COLUMBIA PIKE APT 125
ARLINGTON VA
22204-4453
US

IV. Provider business mailing address

1301 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-3027
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: