Provider Demographics
NPI:1184093700
Name:OLTROGGE, KRISTINA KAY (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KAY
Last Name:OLTROGGE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:KAY
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:951 204TH PL
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7906
Mailing Address - Country:US
Mailing Address - Phone:641-629-1473
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-254-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083128225X00000X
GAOT006271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist