Individual
KEVIN KISIEDU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
8501 ARLINGTON BLVD, FAIRFAX, VA 22031-4617
(703) 205-1919
Mailing address
16740 FLOTILLA WAY, WOODBRIDGE, VA 22191-6301
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119-009208
VA
Other
Enumeration date
08/02/2021
Last updated
09/01/2021
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