Provider Demographics
NPI:1134169998
Name:VARNER, KRISTA D (OT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:D
Last Name:VARNER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 1024
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-9684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 E MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2160
Practice Address - Country:US
Practice Address - Phone:717-242-4840
Practice Address - Fax:717-242-4841
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003686L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014747830001Medicaid
PA075149R9XMedicare Oscar/Certification