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General NPI Number Information
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NPI Number | 1063967685
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Entity Type | Individual
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Provider Name | KATELYN KRESSE-SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 9010 WOODMAN RD
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City | RICHMOND
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State | VA
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Zip | 23228-2148
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Country | US
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Telephone | 804-330-6123
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Fax | 804-330-6127
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Provider Business Mailing Address
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Address Line | 1611 GEORGIA AVE
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City | RICHMOND
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State | VA
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Zip | 23220-6805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119006931
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License Number State | VA
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