Kierstin Fafulovic, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

5201009369 Issued in MI

Practice address

115 S Ludlow St
Dayton, OH 45402-1812

Phone

(937) 542-3000

Fax

(937) 542-3202

NPI assigned

Oct 31, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kierstin Leak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767657600000",
    "number": "1437793601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2936 GREEN VISTA DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454318743",
            "telephone_number": "937-474-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 S LUDLOW ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454021812",
            "telephone_number": "937-542-3000",
            "fax_number": "937-542-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAFULOVIC",
        "first_name": "KIERSTIN",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MI",
            "license": "5201009369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIERSTIN",
            "last_name": "LEAK",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Megan A Ezzo, FNP-C
• Miki Faber, RN
• Milena Fabry
• Craig Fada
• Maria Fada, DO
• Siobhan E Fagan, M.ED., AT, ATC, CSCS
• Fail Me Not Tutoring
• Leathia Fails
• Kayla Fair, RN
• Stephanie Fair

• Occupational Therapist in Dayton, OH
• Providers in Dayton, OH by specialty
• Occupational Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.