Healthcare Provider Details

I. General information

NPI: 1265715098
Provider Name (Legal Business Name): KRISTY LEIGH HEGE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHNSON RIDGE MEDICAL PARK
ELKIN NC
28621-2447
US

IV. Provider business mailing address

400 JOHNSON RIDGE MEDICAL PARK
ELKIN NC
28621-2447
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-0303
  • Fax:
Mailing address:
  • Phone: 336-835-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4802
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14537
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: