Provider Demographics
NPI:1386627800
Name:HOMKA, KRISTEN ANN (OT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ANN
Last Name:HOMKA
Suffix:
Gender:
Credentials:OT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 601791
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1791
Mailing Address - Country:US
Mailing Address - Phone:704-323-3409
Mailing Address - Fax:980-223-4791
Practice Address - Street 1:15825 BALLANTYNE MEDICAL PL STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4790
Practice Address - Country:US
Practice Address - Phone:704-323-3409
Practice Address - Fax:980-223-4791
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4187225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
0397730019Medicare NSC