Provider Demographics
NPI:1083701072
Name:PATTERSON, KIRSTEN ERIN (MA OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ERIN
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 LAKEPOINTE DR
Mailing Address - Street 2:BLDG #1
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5726
Mailing Address - Country:US
Mailing Address - Phone:954-370-8410
Mailing Address - Fax:
Practice Address - Street 1:4710 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-5740
Practice Address - Country:US
Practice Address - Phone:937-233-1230
Practice Address - Fax:937-236-8930
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11786225XP0200X
OH007137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890290900Medicaid
OH4620006OtherUNITED HEALTHCARE GROUP
OH0510772Medicaid
FL890290900Medicaid