MEDICARE: PATRICIA KINGSLEY 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	225XG0600X	Gerontology Occupational Therapist	3914	CA

General Provider Information

NPI Number	:	1932487378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KINGSLEY OTR/L

Provider Business Mailing Address
First Line	:	1216 2ND AVE
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95965-4708
Country	:	US
Telephone Number	:	530-403-7731
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GILMORE LN
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-5147
Country	:	US
Telephone Number	:	530-403-7731
Fax Number	:

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	08/03/2011

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Directions to “ PATRICIA KINGSLEY OTR/L” Practice Location

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