Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0119008753 | VA |
NPI | 1225643067 |
---|---|
Provider Name | Kyle Chacko Thomas |
First Address | Chantilly, VA 20152-6438 |
Second Address | Fairfax, VA 22030-7174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 09/09/2020 |