Provider Demographics
NPI:1417412156
Name:VIRA, KASTURI NAREN (OTR)
Entity type:Individual
Prefix:
First Name:KASTURI
Middle Name:NAREN
Last Name:VIRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15610 TWIN VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1042
Mailing Address - Country:US
Mailing Address - Phone:301-570-0075
Mailing Address - Fax:
Practice Address - Street 1:901 ARCOLA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3401
Practice Address - Country:US
Practice Address - Phone:301-570-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist