Provider Demographics
NPI:1235249889
Name:MACLEAN-TALBOT, KRISTINE
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:MACLEAN-TALBOT
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 1:1144 NW STANNIUM RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2141
Mailing Address - Country:US
Mailing Address - Phone:207-299-7796
Mailing Address - Fax:
Practice Address - Street 1:450 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1531
Practice Address - Country:US
Practice Address - Phone:542-923-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5750OtherLICENSE #
MEPT2928OtherLICENSE #