Provider Demographics
NPI:1679789523
Name:PHILLIPS, KRISTIE PRESSLER (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:PRESSLER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 SEQUOYAH DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-0246
Mailing Address - Country:US
Mailing Address - Phone:479-621-0507
Mailing Address - Fax:
Practice Address - Street 1:1004 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4208
Practice Address - Country:US
Practice Address - Phone:479-254-6717
Practice Address - Fax:479-254-6761
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1631225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics