Provider Demographics
NPI:1780108803
Name:LUTSCH, KRISTEN (OTRL)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LUTSCH
Suffix:
Gender:
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 ORION RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1655
Mailing Address - Country:US
Mailing Address - Phone:317-828-5930
Mailing Address - Fax:
Practice Address - Street 1:4330 ORION RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1655
Practice Address - Country:US
Practice Address - Phone:317-828-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist