Provider Demographics
NPI:1861975690
Name:STANLEY, KRISTEN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12828 W STONEY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PARKER CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47368-9630
Mailing Address - Country:US
Mailing Address - Phone:765-644-0500
Mailing Address - Fax:765-378-9019
Practice Address - Street 1:12828 W STONEY CREEK LN
Practice Address - Street 2:
Practice Address - City:PARKER CITY
Practice Address - State:IN
Practice Address - Zip Code:47368-9630
Practice Address - Country:US
Practice Address - Phone:765-644-0500
Practice Address - Fax:765-378-9019
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist