Provider Demographics
NPI:1710173232
Name:FARRIS, KATHLEEN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FARRIS
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 1:1602 BELLE VIEW BLVD # 3189
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6531
Mailing Address - Country:US
Mailing Address - Phone:314-458-6313
Mailing Address - Fax:
Practice Address - Street 1:1602 BELLE VIEW BLVD # 3189
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6531
Practice Address - Country:US
Practice Address - Phone:716-969-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006040225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics