Individual
KIEIFI A MYRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
102 ELDEN ST STE 12, HERNDON, VA 20170-4839
(703) 587-8999
Mailing address
5252 LYNGATE CT STE 203, BURKE, VA 22015-1673
(703) 239-2300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119008122
VA
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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