Kaelove Brena Richardson

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

15070 Issued in NC

Practice address

601 S Martin Luther King Jr Dr FL 432
Winston Salem, NC 27110-0003

Phone

(333) 750-2000

NPI assigned

Sep 5, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Complete Rehabilitation and Sports Physical Therapy, PC

  • Physical Therapist
  • Ronkonkoma, NY
  • NPI 1811097306
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1134733272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 OLD OAK DR APT B7",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271066064",
            "telephone_number": "803-608-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S MARTIN LUTHER KING JR DR FL 432",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271100003",
            "telephone_number": "333-750-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Market St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275164493",
            "country_code": "US",
            "telephone_number": "984-528-8787",
            "fax_number": "984-246-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KAELOVE",
        "middle_name": "BRENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-05",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NC",
            "license": "15070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Camden Austin Richardson, DO
• Chad Maurice Richardson, MD
• D'Juan Amaud Richardson, DC
• Emmett Richardson
• Heather Leigh Richardson, FNP-C
• Karl Matthew Richardson, MD
• Katherine Hughes Richardson, MA
• Kinsey Richardson, PHARMD
• Summer Richardson, CPNP-PC
• Nori Richen, MS, CGC

• Occupational Therapist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Occupational Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.