Individual
KRISTA VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
(260) 484-5059
Mailing address
3320 N CLINTON ST, FORT WAYNE, IN 46805-1918
(260) 483-2100
(260) 484-5059
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31004498A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000530791
ANTHEM
IN
05
—
200868170
—
IN
Enumeration date
10/31/2007
Last updated
11/13/2008
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