Healthcare Provider Details

I. General information

NPI: 1487423034
Provider Name (Legal Business Name): KELLY NICOLE ROMBERGER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 WALLER RD STE 200
RICHMOND VA
23230-2912
US

IV. Provider business mailing address

2824 E BROAD ST APT 1
RICHMOND VA
23223-7479
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-5010
  • Fax:
Mailing address:
  • Phone: 570-991-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119010463
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: