MEDICARE: DR. KRISTEN LUNDY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	31006955A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	424597	OTHER		NBCOT

General Provider Information

NPI Number	:	1225650963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN LUNDY OTR

Provider Business Mailing Address
First Line	:	210 OGDON ST
Second Line	:
City	:	WASHINGTON
State	:	IN
Zip	:	47501-2537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2002 ALBANY ST
Second Line	:
City	:	BEECH GROVE
State	:	IN
Zip	:	46107-1408
Country	:	US
Telephone Number	:	317-783-2911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2020
Last Update Date	:	05/16/2020

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