MEDICARE: KATRINA REICHARDT

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	246ZE0500X	EEG Specialist/Technologist

General Provider Information

NPI Number	:	1588122436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA REICHARDT

Provider Business Mailing Address
First Line	:	7518 QUIET FOREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-2625
Country	:	US
Telephone Number	:	832-377-9425
Fax Number	:

Provider Business Practice Location Address
First Line	:	3308 ELLA BLVD STE L
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-7336
Country	:	US
Telephone Number	:	832-377-9425
Fax Number	:

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

Provider Enumeration Date	:	03/11/2019
Last Update Date	:	03/11/2019

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Directions to “ KATRINA REICHARDT ” Practice Location

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