Healthcare Provider Details

I. General information

NPI: 1396238366
Provider Name (Legal Business Name): KRISTINE LEE TAYLOR OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 WHITING AVE
STEVENS POINT WI
54481-5246
US

IV. Provider business mailing address

815 COMMONS CIR APT 5
PLOVER WI
54467-4229
US

V. Phone/Fax

Practice location:
  • Phone: 715-345-5350
  • Fax:
Mailing address:
  • Phone: 715-412-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2376-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: