MEDICARE: KASEY LYNN SYDNOR

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	224Z00000X	Occupational Therapy Assistant	0131002350	VA

General Provider Information

NPI Number	:	1548879711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY LYNN SYDNOR

Provider Business Mailing Address
First Line	:	120 GREEN SPRING RD
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22603-2739
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 GREEN SPRING RD
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22603-2739
Country	:	US
Telephone Number	:	540-539-8173
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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