Provider Demographics
NPI:1215532387
Name:REIBLING, KRIS VAUGHN (OTR/L)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:VAUGHN
Last Name:REIBLING
Suffix:
Gender:M
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 1:13640 ARAGON WAY APT 4108
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5588
Mailing Address - Country:US
Mailing Address - Phone:502-380-7654
Mailing Address - Fax:
Practice Address - Street 1:13640 ARAGON WAY APT 4108
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5588
Practice Address - Country:US
Practice Address - Phone:502-380-7654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263598225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics