Provider Demographics
NPI:1164730354
Name:ALLEN, KATHRYN D (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 FARRELL RD STE GC-11
Mailing Address - Street 2:ATTN MCXC- CREDENTIALS
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:703-805-0881
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL RD STE GC-11
Practice Address - Street 2:ATTN MCXC- CREDENTIALS
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT010000517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist