Provider Demographics
NPI:1275867988
Name:REPP, KRISTI NICOLE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KRISTI
Middle Name:NICOLE
Last Name:REPP
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 1:9930 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-8110
Mailing Address - Country:US
Mailing Address - Phone:301-514-5142
Mailing Address - Fax:
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3993
Practice Address - Country:US
Practice Address - Phone:210-615-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist