Provider Demographics
NPI:1891938031
Name:WILSON, KRISTA KENDALL (OTD, CHT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:KENDALL
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTD, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CAMPUS DR STE 128
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7542
Mailing Address - Country:US
Mailing Address - Phone:304-596-5193
Mailing Address - Fax:304-596-5194
Practice Address - Street 1:61 CAMPUS DR STE 128
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7542
Practice Address - Country:US
Practice Address - Phone:304-596-5193
Practice Address - Fax:304-596-5194
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06207225X00000X
WV1380225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist