Provider Demographics
NPI:1164543807
Name:MONETTE, KRISTEN (ATC, MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MONETTE
Suffix:
Gender:F
Credentials:ATC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 SOFTWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4241
Mailing Address - Country:US
Mailing Address - Phone:541-231-2898
Mailing Address - Fax:
Practice Address - Street 1:1709 SOFTWOOD WAY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-4241
Practice Address - Country:US
Practice Address - Phone:541-231-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer