Provider Demographics
NPI:1487958450
Name:RE, KRISTIN JEANNE (OTDR/L)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JEANNE
Last Name:RE
Suffix:
Gender:F
Credentials:OTDR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 THAYER DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3363
Mailing Address - Country:US
Mailing Address - Phone:503-260-3265
Mailing Address - Fax:
Practice Address - Street 1:1015 THAYER DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3363
Practice Address - Country:US
Practice Address - Phone:503-260-3265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007646225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist