MEDICARE: KATELYN KRESSE-SMITH

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	225X00000X	Occupational Therapist	0119006931	VA

General Provider Information

NPI Number	:	1063967685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN KRESSE-SMITH

Provider Business Mailing Address
First Line	:	1611 GEORGIA AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-6805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 WOODMAN RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2148
Country	:	US
Telephone Number	:	804-330-6123
Fax Number	:	804-330-6127

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

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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Directions to “ KATELYN KRESSE-SMITH ” Practice Location

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