Healthcare Provider Details

I. General information

NPI: 1245045798
Provider Name (Legal Business Name): KRISTA TAYLOR OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA STRICKLAND

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 US HIGHWAY 17
FLEMING ISLAND FL
32003-4825
US

IV. Provider business mailing address

3088 HAVENGATE DR
GREEN COVE SPRINGS FL
32043-7203
US

V. Phone/Fax

Practice location:
  • Phone: 904-637-0148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25894
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: