Provider Demographics
NPI:1326309865
Name:DIETRICH, KATHRYN JOAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:JOAN
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7032 KINGS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5641
Mailing Address - Country:US
Mailing Address - Phone:316-617-5623
Mailing Address - Fax:
Practice Address - Street 1:6929 MATTHEW PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3607
Practice Address - Country:US
Practice Address - Phone:703-813-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119005189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist