Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 0119000401 | VA |
NPI | 1659406254 |
---|---|
Provider Name | Joann Cook Kennedy |
First Address | Fairfax, VA 22032-3930 |
Second Address | Fairfax, VA 22032-3930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 17/01/2008 |