MEDICARE: KRISTINA STEWART OTR/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1104409887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA STEWART OTR/L

Provider Business Mailing Address
First Line	:	6 W MOUNT IDA AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 PROSPERITY DR STE 430
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1652
Country	:	US
Telephone Number	:	301-777-2000
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	04/30/2021

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Directions to “ KRISTINA STEWART OTR/L” Practice Location

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