Provider Demographics
NPI:1063883676
Name:GENO, KRISTI LEA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LEA
Last Name:GENO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5672 3 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9031
Mailing Address - Country:US
Mailing Address - Phone:989-450-0315
Mailing Address - Fax:
Practice Address - Street 1:564 W HAMPTON RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-9710
Practice Address - Country:US
Practice Address - Phone:989-892-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist