Healthcare Provider Details

I. General information

NPI: 1477095909
Provider Name (Legal Business Name): KATHLEEN GEDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 AVINITY LOOP
CHARLOTTESVILLE VA
22902-5784
US

IV. Provider business mailing address

2142 AVINITY LOOP
CHARLOTTESVILLE VA
22902-5784
US

V. Phone/Fax

Practice location:
  • Phone: 757-879-6911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119006944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: