Provider Demographics
NPI:1134720188
Name:GAETANO, KIANA
Entity type:Individual
Prefix:
First Name:KIANA
Middle Name:
Last Name:GAETANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CRYSTAL DR APT 624
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3570
Mailing Address - Country:US
Mailing Address - Phone:724-719-1851
Mailing Address - Fax:
Practice Address - Street 1:6715 LITTLE RIVER TPKE STE 200
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-879-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6202225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0119010774OtherVIRGINIA OCCUPATIONAL THERAPY LICENSE
MD10246OtherMARYLAND OCCUPATIONAL THERAPY LICENSE
CO9000195060Medicaid