Provider Demographics
NPI:1174040448
Name:PRENCAVAGE, KATELYN SARA (MOT OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:SARA
Last Name:PRENCAVAGE
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 TOPSHAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2651
Mailing Address - Country:US
Mailing Address - Phone:267-546-7855
Mailing Address - Fax:
Practice Address - Street 1:6410 COURTS DR
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-2562
Practice Address - Country:US
Practice Address - Phone:804-733-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014909225X00000X
VA0119008636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist