Provider Demographics
NPI:1811277965
Name:WILLOUGHBY, KRISTI BRITTON (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:BRITTON
Last Name:WILLOUGHBY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 JUNIOR HIGH SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND NECK
Mailing Address - State:NC
Mailing Address - Zip Code:27874
Mailing Address - Country:US
Mailing Address - Phone:252-826-4144
Mailing Address - Fax:
Practice Address - Street 1:921 JUNIOR HIGH SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874
Practice Address - Country:US
Practice Address - Phone:252-826-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant