Provider Demographics
NPI:1720401888
Name:RYZHIKOV, KATIE FRANCESCA (MSOT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:FRANCESCA
Last Name:RYZHIKOV
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 GODSPEED RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-1302
Mailing Address - Country:US
Mailing Address - Phone:240-421-3154
Mailing Address - Fax:
Practice Address - Street 1:3478 GODSPEED RD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035-1302
Practice Address - Country:US
Practice Address - Phone:240-421-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist