Provider Demographics
NPI:1124084264
Name:GREGORY, KRISTI (MS OTRL CHT)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-915-4607
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1115 BOULDERS PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4067
Practice Address - Country:US
Practice Address - Phone:804-330-8165
Practice Address - Fax:804-287-2786
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124084264Medicaid
VA192945OtherBCBS OCCUPATIONAL THERAPY
VA7261398OtherAETNA
VAP00425882OtherRAILROAD MEDICARE
VA192945OtherBCBS OCCUPATIONAL THERAPY
VA014953T54Medicare PIN