Basic Information
| Provider Information | |||||||||
| NPI: | 1619427994 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UTLEY | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7433 EDGEDALE DR | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476302954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124833451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1595 S US HIGHWAY 231 | ||||||||
| Address2: | |||||||||
| City: | BEAVER DAM | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423209463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702749646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2016 | ||||||||
| LastUpdateDate: | 10/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 166674 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.