Provider Demographics
NPI:1952646192
Name:STENSON, KRISTIN ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:STENSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANN
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 TAHOE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7957
Mailing Address - Country:US
Mailing Address - Phone:859-230-7952
Mailing Address - Fax:
Practice Address - Street 1:233 TAHOE WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7957
Practice Address - Country:US
Practice Address - Phone:859-230-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4341171W00000X
KY135018225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100680340Medicaid