Provider Demographics
NPI:1164891693
Name:FRICKE, KRISTIN LEA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEA
Last Name:FRICKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:LEA
Other - Last Name:FARSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:420 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2667
Mailing Address - Country:US
Mailing Address - Phone:402-537-6222
Mailing Address - Fax:
Practice Address - Street 1:420 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2667
Practice Address - Country:US
Practice Address - Phone:402-537-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE552225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist