MEDICARE: MARY-KATHERINE DAVIDSON-TAYLOR M.S. OTR/L

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	225X00000X	Occupational Therapist	0119003260	VA
2	225XP0200X	Pediatric Occupational Therapist	0119003260	VA

General Provider Information

NPI Number	:	1427222306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY-KATHERINE DAVIDSON-TAYLOR M.S. OTR/L

Provider Business Mailing Address
First Line	:	3508 FORT HILL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2105
Country	:	US
Telephone Number	:	703-862-6557
Fax Number	:	703-329-1187

Provider Business Practice Location Address
First Line	:	3508 FORT HILL DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-2105
Country	:	US
Telephone Number	:	703-862-6557
Fax Number	:	703-329-1187

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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