MEDICARE: KIMBERLY FRYE OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	108636	TX
2	225X00000X	Occupational Therapist	119007043	VA

General Provider Information

NPI Number	:	1760730550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY FRYE OTR

Provider Business Mailing Address
First Line	:	520 12TH ST S
Second Line	:	622
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4223
Country	:	US
Telephone Number	:	210-885-3496
Fax Number	:

Provider Business Practice Location Address
First Line	:	8115 GATEHOUSE RD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-1203
Country	:	US
Telephone Number	:	571-423-4864
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	03/17/2018

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