Healthcare Provider Details

I. General information

NPI: 1093915548
Provider Name (Legal Business Name): KRISTINA R PALEY OTC, COF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5899 BREMO RD 1ST FLOOR
RICHMOND VA
23226-1935
US

IV. Provider business mailing address

9210 ARBORETUM PKWY SUITE 260
RICHMOND VA
23236-3472
US

V. Phone/Fax

Practice location:
  • Phone: 804-433-2080
  • Fax: 804-433-2099
Mailing address:
  • Phone: 804-915-4602
  • Fax: 804-327-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC20034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: