MEDICARE: KRISTEN MARIE RICHARDS-OTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146009575	IL
2	235Z00000X	Speech-Language Pathologist	123306	TX

General Provider Information

NPI Number	:	1063669513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARIE RICHARDS-OTT

Provider Business Mailing Address
First Line	:	1016 N STRATFORD RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5842
Country	:	US
Telephone Number	:	847-749-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 N STRATFORD RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-5842
Country	:	US
Telephone Number	:	847-749-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	01/06/2025

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Directions to “ KRISTEN MARIE RICHARDS-OTT ” Practice Location

Language	Start Address	Practice Location

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