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General NPI Number Information
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NPI Number | 1659199255
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Entity Type | Individual
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Provider Name | KARLY GRACE GUDYKUNST OTR
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 5400 SHAWNEE RD STE 104
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2300
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Country | US
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Telephone | 703-256-4830
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Fax |
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Provider Business Mailing Address
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Address Line | 4209 RIDGE TOP RD APT 459
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City | FAIRFAX
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State | VA
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Zip | 22030-1122
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Country | US
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Telephone | 570-702-5781
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119010664
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License Number State | VA
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