Healthcare Provider Details

I. General information

NPI: 1972200269
Provider Name (Legal Business Name): KRISTA RAPP OTD, OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA KLUKAN

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 17TH AVE W
BRADENTON FL
34209-7838
US

IV. Provider business mailing address

5924 29TH AVE W BLDG 4
BRADENTON FL
34209-7003
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax:
Mailing address:
  • Phone: 724-954-7063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT23761
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: