Provider Demographics
NPI:1659603488
Name:VANWAGNER, KRISTEN L (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
Last Name:VANWAGNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9402 JONATHAN PL
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8029
Mailing Address - Country:US
Mailing Address - Phone:502-551-4030
Mailing Address - Fax:
Practice Address - Street 1:9402 JONATHAN PL
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8029
Practice Address - Country:US
Practice Address - Phone:502-551-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2538225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist