Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119001265 | VA |
Y | 225XH1200X | Occupational Therapist - Hand | 0119001265 | VA |
NPI | 1205218138 |
---|---|
Provider Name | Kanchanmala Akmanchi |
First Address | Ashburn, VA 20147-3403 |
Second Address | Ashburn, VA 20147-3403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2015 |
Last Update Date | 27/06/2015 |