Provider Demographics
NPI:1003568593
Name:LEVAN, KIRSTEN NICOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:NICOLE
Last Name:LEVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 GREY FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-2716
Mailing Address - Country:US
Mailing Address - Phone:484-464-5531
Mailing Address - Fax:
Practice Address - Street 1:5904 GREY FOX DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-2716
Practice Address - Country:US
Practice Address - Phone:484-464-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology