Healthcare Provider Details

I. General information

NPI: 1952646192
Provider Name (Legal Business Name): KRISTIN ANN STENSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN ANN WYATT

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 HARTLAND PKWY STE 268
LEXINGTON KY
40515-1558
US

IV. Provider business mailing address

233 TAHOE WAY
RICHMOND KY
40475-7957
US

V. Phone/Fax

Practice location:
  • Phone: 859-230-7952
  • Fax:
Mailing address:
  • Phone: 859-230-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberR4341
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number135018
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number135018
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: