Healthcare Provider Details

I. General information

NPI: 1366798340
Provider Name (Legal Business Name): KK ASSISTIVE TECHNOLOGY & THERAPY PRODUCTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WESTWOOD OFFICE PARK
FREDERICKSBURG VA
22401-5121
US

IV. Provider business mailing address

14 PENNINGCROFT LN
FREDERICKSBURG VA
22406-8201
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-6057
  • Fax: 651-436-0283
Mailing address:
  • Phone: 571-223-6057
  • Fax: 651-436-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAVITA ARORA
Title or Position: REPRESENTATIVE
Credential: PHD., MS OTR
Phone: 571-223-6057