=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235765694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN RITCHIE OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2020
-----------------------------------------------------
Last Update Date | 03/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 406 WYOMING RD
-----------------------------------------------------
City | OWINGSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40360-8906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-674-6613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 916 VILLA DR APT 13
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40475-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-568-8724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 262110
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------