Healthcare Provider Details

I. General information

NPI: 1447164694
Provider Name (Legal Business Name): KRISTIN PAIGE CARDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4823 S LABURNUM AVE STE C
HENRICO VA
23231-2713
US

IV. Provider business mailing address

2605 MEADOW LN
RUTHER GLEN VA
22546-2817
US

V. Phone/Fax

Practice location:
  • Phone: 804-533-2622
  • Fax:
Mailing address:
  • Phone: 540-760-8925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131002372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: