Provider Demographics
NPI:1528243474
Name:VISAND, KRISTI RENE (COTA-L)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:RENE
Last Name:VISAND
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 GRAND AVE
Mailing Address - Street 2:APT 12
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4642
Mailing Address - Country:US
Mailing Address - Phone:515-890-7150
Mailing Address - Fax:
Practice Address - Street 1:5406 MERLE HAY RD
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1209
Practice Address - Country:US
Practice Address - Phone:515-727-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000784224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant