Provider Demographics
NPI:1467792010
Name:EGLIAN, KRISTA (COTA/L)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:EGLIAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-8568
Mailing Address - Country:US
Mailing Address - Phone:859-694-1355
Mailing Address - Fax:
Practice Address - Street 1:3699 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE D
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-1789
Practice Address - Country:US
Practice Address - Phone:859-572-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA . 04834224Z00000X
KYA5073224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant