Healthcare Provider Details

I. General information

NPI: 1457409823
Provider Name (Legal Business Name): KRISTY STAMPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTY BARBER

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-4081
  • Fax:
Mailing address:
  • Phone: 859-224-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR2169
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number133770
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: