Provider Demographics
NPI:1659603488
Name:MARTIN, KRISTEN LEIGH (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:MARTIN
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 1:6520 MANASSAS DR
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-9060
Mailing Address - Country:US
Mailing Address - Phone:502-241-4337
Mailing Address - Fax:
Practice Address - Street 1:6520 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:PEWEE VALLEY
Practice Address - State:KY
Practice Address - Zip Code:40056-9060
Practice Address - Country:US
Practice Address - Phone:502-241-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist