Provider Demographics
NPI:1164653176
Name:MARSHALL, KRISTY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MARSHALL
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 1:144 MACKINLEY CIR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-5644
Mailing Address - Country:US
Mailing Address - Phone:949-357-3689
Mailing Address - Fax:
Practice Address - Street 1:407 CHURCH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-3792
Practice Address - Country:US
Practice Address - Phone:843-520-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1221225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics