MEDICARE: KIMBERLY ANNE STYCHE 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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1568003838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE STYCHE OTR/L

Provider Business Mailing Address
First Line	:	812 CAROLE SUMMEY DR
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-0248
Country	:	US
Telephone Number	:	412-651-3629
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 W MATTHEWS ST STE 203
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-1310
Country	:	US
Telephone Number	:	704-995-2900
Fax Number	:

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

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/08/2019

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