Provider Demographics
NPI:1164987061
Name:KITZLER, KRISTY SUE
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:SUE
Last Name:KITZLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MARTINSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-4225
Mailing Address - Country:US
Mailing Address - Phone:740-393-6767
Mailing Address - Fax:
Practice Address - Street 1:207 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-8021
Practice Address - Country:US
Practice Address - Phone:740-625-6488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT001358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist