Individual
KAELOVE BRENA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 S MARTIN LUTHER KING JR DR FL 432, WINSTON SALEM, NC 27110-0003
(333) 750-2000
Mailing address
5211 OLD OAK DR APT B7, WINSTON SALEM, NC 27106-6064
(803) 608-6475
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
15070
NC
225X00000X
Occupational Therapist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
09/05/2020
Last updated
09/17/2024
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