Provider Demographics
NPI:1902051287
Name:PARRIS, KRISTIN WESLEY (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:WESLEY
Last Name:PARRIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8691 HAWLEY GIBSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-7401
Mailing Address - Country:US
Mailing Address - Phone:502-550-2208
Mailing Address - Fax:
Practice Address - Street 1:8691 HAWLEY GIBSON ROAD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7401
Practice Address - Country:US
Practice Address - Phone:502-550-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4039225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50033725OtherPASSPORT
KY000000665938OtherANTHEM