Provider Demographics
NPI:1174859110
Name:LASTINGER, KARIN (OT)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:LASTINGER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SE 7TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4891
Mailing Address - Country:US
Mailing Address - Phone:352-795-4114
Mailing Address - Fax:352-563-2438
Practice Address - Street 1:255 SE 7TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4891
Practice Address - Country:US
Practice Address - Phone:352-795-4114
Practice Address - Fax:352-563-2438
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13654225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT13654OtherFLORIDA LICIENCE