MEDICARE: MS. KATHI LISA ADAMS OTR

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	0119000225	VA

General Provider Information

NPI Number	:	1821091307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHI LISA ADAMS OTR

Provider Business Mailing Address
First Line	:	1849 W PLAZA DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	540-535-0777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 W PLAZA DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-6365
Country	:	US
Telephone Number	:	540-535-0777
Fax Number	:

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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