Provider Demographics
NPI:1154753374
Name:LEWIS, KRISANNE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISANNE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 ALTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-6065
Mailing Address - Country:US
Mailing Address - Phone:801-657-9676
Mailing Address - Fax:
Practice Address - Street 1:540 S ARAPEEN DR STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1216
Practice Address - Country:US
Practice Address - Phone:801-585-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50138884201225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics