Provider Demographics
NPI:1902170079
Name:LUTZEL, KRISTEN JEAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:LUTZEL
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 1:1670 WINDY PINES DR
Mailing Address - Street 2:UNIT 3
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-7584
Mailing Address - Country:US
Mailing Address - Phone:239-774-1257
Mailing Address - Fax:
Practice Address - Street 1:1670 WINDY PINES DR
Practice Address - Street 2:UNIT 3
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-7584
Practice Address - Country:US
Practice Address - Phone:239-774-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13871225X00000X
CT003891225X00000X
RI01371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist