Healthcare Provider Details

I. General information

NPI: 1912006057
Provider Name (Legal Business Name): KRISTINE A SECREST OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 N STATE ROAD 434 STE 1128
ALTAMONTE SPRINGS FL
32714-7061
US

IV. Provider business mailing address

990 N STATE ROAD 434 STE 1128
ALTAMONTE SPRINGS FL
32714-7061
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-3967
  • Fax: 321-842-3968
Mailing address:
  • Phone: 321-842-3967
  • Fax: 321-842-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2762
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0002762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: