=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255056008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTY WOODFORD OTD, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2022
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 RETREAT LN
-----------------------------------------------------
City | HUDDLESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24104-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-227-6086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8989 LEESVILLE RD
-----------------------------------------------------
City | HUDDLESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24104-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119009112
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------