MEDICARE: MS. KATHIE L STOLTZFUS MS OTRL

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	225XP0200X	Pediatric Occupational Therapist	04205	MD
2	225XP0200X	Pediatric Occupational Therapist	0119003714	VA
3	225XP0200X	Pediatric Occupational Therapist	827	DC

General Provider Information

NPI Number	:	1235345273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHIE L STOLTZFUS MS OTRL

Provider Business Mailing Address
First Line	:	6521 ARLINGTON BLVD
Second Line	:	SUITE 312
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-3016
Country	:	US
Telephone Number	:	202-997-1286
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 ARLINGTON BLVD
Second Line	:	SUITE 312
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-3016
Country	:	US
Telephone Number	:	202-997-1286
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	02/12/2012

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