Provider Demographics
NPI:1619427994
Name:UTLEY, KRISTEN (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:UTLEY
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 1:7433 EDGEDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2954
Mailing Address - Country:US
Mailing Address - Phone:812-483-3451
Mailing Address - Fax:
Practice Address - Street 1:1595 S US HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-9463
Practice Address - Country:US
Practice Address - Phone:270-274-9646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist