Provider Demographics
NPI:1619546744
Name:YODER, KRISTEN ALLISON (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALLISON
Last Name:YODER
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 1:5761 BUTTERMILK RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-9633
Mailing Address - Country:US
Mailing Address - Phone:717-496-7709
Mailing Address - Fax:
Practice Address - Street 1:1304 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3108
Practice Address - Country:US
Practice Address - Phone:301-733-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014856225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist