Healthcare Provider Details

I. General information

NPI: 1770150500
Provider Name (Legal Business Name): KRISTEN TAYLOR QUIJADA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LEXINGTON RD STE A&B
RICHMOND KY
40475-7924
US

IV. Provider business mailing address

354 PEACHTREE DR
BEREA KY
40403-9128
US

V. Phone/Fax

Practice location:
  • Phone: 859-353-5445
  • Fax:
Mailing address:
  • Phone: 859-339-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number269019
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: