Provider Demographics
NPI:1750420683
Name:BARDI, KRISTINE (MS, OTRL)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:BARDI
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3263
Mailing Address - Country:US
Mailing Address - Phone:847-599-9667
Mailing Address - Fax:847-599-9669
Practice Address - Street 1:4525 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3263
Practice Address - Country:US
Practice Address - Phone:847-599-9667
Practice Address - Fax:847-599-9669
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04928078OtherBCBS PROVIDER NUMBER