Provider Demographics
NPI:1497065171
Name:WOOD, KRISTEN LAMPHEAR (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LAMPHEAR
Last Name:WOOD
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 1:1452 STATE ROUTE 264
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-2155
Mailing Address - Country:US
Mailing Address - Phone:315-592-5823
Mailing Address - Fax:
Practice Address - Street 1:639 COUNTY ROUTE 22
Practice Address - Street 2:
Practice Address - City:PARISH
Practice Address - State:NY
Practice Address - Zip Code:13131-3182
Practice Address - Country:US
Practice Address - Phone:315-625-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008501174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist