Provider Demographics
NPI:1619361391
Name:SHOWALTER, KRISTEN HEATHER (OTR/L, LMT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HEATHER
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:OTR/L, LMT
Other - Prefix:
Other - First Name:KRISHA
Other - Middle Name:
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L, LMT
Mailing Address - Street 1:4 LOUISE PL
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6124
Mailing Address - Country:US
Mailing Address - Phone:646-234-6729
Mailing Address - Fax:
Practice Address - Street 1:3840 HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7277
Practice Address - Country:US
Practice Address - Phone:817-569-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016038225700000X
NY018022225X00000X
TX118574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist