Healthcare Provider Details

I. General information

NPI: 1558146308
Provider Name (Legal Business Name): KRISTI WALLIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 E FLORIDA AVE STE 917
DENVER CO
80210-2549
US

IV. Provider business mailing address

3801 E FLORIDA AVE STE 917
DENVER CO
80210-2549
US

V. Phone/Fax

Practice location:
  • Phone: 844-757-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0008076
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: