Provider Demographics
NPI:1053634576
Name:JONES, KRISTIN (MSOT/OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MSOT/OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 VERBENIA DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2545
Mailing Address - Country:US
Mailing Address - Phone:270-871-5661
Mailing Address - Fax:
Practice Address - Street 1:1634 SALADINO ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-5425
Practice Address - Country:US
Practice Address - Phone:270-871-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24960225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist