Healthcare Provider Details

I. General information

NPI: 1891028114
Provider Name (Legal Business Name): OT 4 KIDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PATRICK HENRY DR
ARLINGTON VA
22205-3517
US

IV. Provider business mailing address

1125 PATRICK HENRY DR
ARLINGTON VA
22205-3517
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-7320
  • Fax:
Mailing address:
  • Phone: 703-237-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN WILLIAM PULKET
Title or Position: VICE PRESIDENT
Credential:
Phone: 703-447-4699