Provider Demographics
NPI:1093089229
Name:FESSENDEN, KRISTI ANN
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANN
Last Name:FESSENDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JACKSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3174
Mailing Address - Country:US
Mailing Address - Phone:615-851-5350
Mailing Address - Fax:615-851-5399
Practice Address - Street 1:930 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3653
Practice Address - Country:US
Practice Address - Phone:941-486-5444
Practice Address - Fax:941-486-5489
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10517224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant