MEDICARE: KRISTINA ANDERSON

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	OT.006806	OH

General Provider Information

NPI Number	:	1629288790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA ANDERSON

Provider Business Mailing Address
First Line	:	325 BRADDIE CV
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-8303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 OAK ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2507
Country	:	US
Telephone Number	:	513-751-0880
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ KRISTINA ANDERSON ” Practice Location

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