Provider Demographics
NPI:1942344544
Name:WORRELL, KRISTI KAY (OTR-L)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAY
Last Name:WORRELL
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 1:908 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7074
Mailing Address - Country:US
Mailing Address - Phone:715-381-7051
Mailing Address - Fax:
Practice Address - Street 1:2495 MAPLEWOOD DRIVE
Practice Address - Street 2:SUITE 313
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1913
Practice Address - Country:US
Practice Address - Phone:651-770-8884
Practice Address - Fax:651-770-8151
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100591225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics