Provider Demographics
NPI:1619493335
Name:LORENZ, KRISTA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:LORENZ
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 1:5891 MAXFLI LN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4844
Mailing Address - Country:US
Mailing Address - Phone:513-526-3980
Mailing Address - Fax:
Practice Address - Street 1:4631 HICKORY WOODS LN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4517
Practice Address - Country:US
Practice Address - Phone:513-398-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004784225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT004784OtherOHIO OCCUPATIONAL THERAPY LICENSE