Provider Demographics
NPI:1922211127
Name:HUNTLEY, KRISTIN SUE (MS AT,C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SUE
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:MS AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 LAUBERT RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9720
Mailing Address - Country:US
Mailing Address - Phone:330-947-3478
Mailing Address - Fax:
Practice Address - Street 1:115 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2926
Practice Address - Country:US
Practice Address - Phone:330-650-9718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0228272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer