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General NPI Number Information
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NPI Number | 1164089280
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Entity Type | Individual
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Provider Name | KRISTINA WARD OTA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 2779 E 15TH ST UNIT 107
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City | CASPER
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State | WY
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Zip | 82609-4144
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Country | US
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Telephone | 720-326-6338
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | MILLS
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State | WY
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Zip | 82644-0081
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0001155
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA-1687
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License Number State | WY
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