Provider Demographics
NPI:1851109888
Name:POLIZZI, KIRSTEN VICTORIA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:VICTORIA
Last Name:POLIZZI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KIRSTEN
Other - Middle Name:VICTORIA
Other - Last Name:POLIZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3301 BEACH PORT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0150
Mailing Address - Country:US
Mailing Address - Phone:608-346-7312
Mailing Address - Fax:
Practice Address - Street 1:7469 W LAKE MEAD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1030
Practice Address - Country:US
Practice Address - Phone:702-550-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist