Provider Demographics
NPI:1619694494
Name:KENNEDY, CHELSEA (MA, ATR)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MA, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3524
Mailing Address - Country:US
Mailing Address - Phone:740-361-5131
Mailing Address - Fax:
Practice Address - Street 1:3925 OLD LEE HWY STE 52B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2426
Practice Address - Country:US
Practice Address - Phone:703-679-8763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty