Healthcare Provider Details

I. General information

NPI: 1255056008
Provider Name (Legal Business Name): KRISTY WOODFORD OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT LN
HUDDLESTON VA
24104-3579
US

IV. Provider business mailing address

8989 LEESVILLE RD
HUDDLESTON VA
24104-3742
US

V. Phone/Fax

Practice location:
  • Phone: 540-227-6086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119009112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: