Provider Demographics
NPI:1235690892
Name:PRICE, KRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:PRICE
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 1:2911 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2303
Mailing Address - Country:US
Mailing Address - Phone:316-516-7950
Mailing Address - Fax:
Practice Address - Street 1:2911 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2303
Practice Address - Country:US
Practice Address - Phone:316-516-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00941225XG0600X
225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-00941OtherKANSAS OCCUPATIONAL THERAPY LICENSE