Healthcare Provider Details

I. General information

NPI: 1295002905
Provider Name (Legal Business Name): KRISTINA MARIE ANDERSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S SCHEUBER ROAD PROVIDENCE CENTRALIA HOSPITAL
CENTRALIA WA
98532
US

IV. Provider business mailing address

914 S SCHEUBER ROAD PROVIDENCE CENTRALIA HOSPITAL
CENTRALIA WA
98532
US

V. Phone/Fax

Practice location:
  • Phone: 360-330-8720
  • Fax: 360-330-8737
Mailing address:
  • Phone: 360-330-8720
  • Fax: 360-330-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60163582
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License NumberOT60163582
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: