Healthcare Provider Details

I. General information

NPI: 1083284038
Provider Name (Legal Business Name): MARY KINMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN STE 200
SPRINGFIELD VA
22152-1650
US

IV. Provider business mailing address

1345 ENTERPRISE DR
WEST CHESTER PA
19380-5964
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax:
Mailing address:
  • Phone:
  • 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: