Provider Demographics
NPI:1487014171
Name:ENOCH, KRISTEN L (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:ENOCH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4080 MCGINNIS FERRY RD BUILDING 300, SUITE 302
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-410-7719
Mailing Address - Fax:770-410-9510
Practice Address - Street 1:4080 MCGINNIS FERRY RD BUILDING 300, SUITE 302
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-410-7719
Practice Address - Fax:770-410-9510
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007243225X00000X
FL17506225X00000X
GA0T007243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist