Provider Demographics
NPI:1245400092
Name:PENOUILH, KRISTI JOYCE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:JOYCE
Last Name:PENOUILH
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 1:1331 AUGUSTUS BEAMON DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-0390
Mailing Address - Country:US
Mailing Address - Phone:225-933-3878
Mailing Address - Fax:
Practice Address - Street 1:1331 AUGUSTUS BEAMON DR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-0390
Practice Address - Country:US
Practice Address - Phone:225-933-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist