Provider Demographics
NPI:1902679863
Name:CONTRERAS, KRISTEN MARIANNA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIANNA
Last Name:CONTRERAS
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 1:304 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3234
Mailing Address - Country:US
Mailing Address - Phone:423-507-3843
Mailing Address - Fax:
Practice Address - Street 1:2090 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3950
Practice Address - Country:US
Practice Address - Phone:423-405-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN501987225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist