Provider Demographics
NPI:1720382757
Name:FORD, KIRSTEN ALICE MYERS (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ALICE MYERS
Last Name:FORD
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 1:1606 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-2780
Mailing Address - Country:US
Mailing Address - Phone:812-238-7000
Mailing Address - Fax:
Practice Address - Street 1:450 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4030
Practice Address - Country:US
Practice Address - Phone:812-238-7000
Practice Address - Fax:812-235-1526
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002801A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31002801AOtherSTATE LICENSE NUMBER