Provider Demographics
NPI:1356808844
Name:SIMS, KATELYNNE MAY (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:KATELYNNE
Middle Name:MAY
Last Name:SIMS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 MADISON AVE S
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-6530
Mailing Address - Country:US
Mailing Address - Phone:540-808-9981
Mailing Address - Fax:
Practice Address - Street 1:164 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9783
Practice Address - Country:US
Practice Address - Phone:276-988-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist