Provider Demographics
NPI:1770702557
Name:GOSS, KRISTA MICHELLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MICHELLE
Last Name:GOSS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 LAKELAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4202
Mailing Address - Country:US
Mailing Address - Phone:205-330-1223
Mailing Address - Fax:
Practice Address - Street 1:2201 32ND ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-5230
Practice Address - Country:US
Practice Address - Phone:205-339-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist