Healthcare Provider Details

I. General information

NPI: 1033043955
Provider Name (Legal Business Name): KRISTA LYNN WHITAKER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CLEAR FORK BR
HAZARD KY
41701-6481
US

IV. Provider business mailing address

207 CLEAR FORK BR
HAZARD KY
41701-6481
US

V. Phone/Fax

Practice location:
  • Phone: 606-260-2681
  • Fax:
Mailing address:
  • Phone: 606-260-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number134501
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: