Provider Demographics
NPI:1326165556
Name:GASS, KRISTA (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GASS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-3555
Mailing Address - Country:US
Mailing Address - Phone:304-229-2515
Mailing Address - Fax:
Practice Address - Street 1:70 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1170
Practice Address - Country:US
Practice Address - Phone:304-724-1101
Practice Address - Fax:304-724-1105
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02025980OtherLIABILITY INSURANCE
VA0119003497OtherOTR LICENSE
WV1281OtherOTR LICENSE