Provider Demographics
NPI:1487779930
Name:DAVIS, KRISTIN K (MS OTR L)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:MS
Other - First Name:KIKI
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR L
Mailing Address - Street 1:654 GOLDEN EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1198
Mailing Address - Country:US
Mailing Address - Phone:717-285-9963
Mailing Address - Fax:
Practice Address - Street 1:600 EDEN ROAD
Practice Address - Street 2:BUILDING I
Practice Address - City:LANCSATER
Practice Address - State:PA
Practice Address - Zip Code:17601-4205
Practice Address - Country:US
Practice Address - Phone:717-299-4829
Practice Address - Fax:717-295-3453
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006310L225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019409590002OtherTYPE17