Provider Demographics
NPI:1083057665
Name:UNDERDOWN, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:UNDERDOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:UNDERDOWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSOT
Mailing Address - Street 1:1210 N VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7001A LOISDALE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1904
Practice Address - Country:US
Practice Address - Phone:703-971-0602
Practice Address - Fax:703-971-0606
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist