Individual
KYLE CHACKO THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
10560 MAIN ST STE 417, FAIRFAX, VA 22030-7174
(703) 717-5667
Mailing address
42090 BARRYMOORE PL, CHANTILLY, VA 20152-6438
(443) 986-4300
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
0119008753
VA
Other
Enumeration date
09/09/2020
Last updated
09/09/2020
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