Provider Demographics
NPI:1245207893
Name:DICKINSON, KRISTINE KARBAN (MS,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:KARBAN
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5964
Mailing Address - Country:US
Mailing Address - Phone:316-618-1252
Mailing Address - Fax:316-869-2277
Practice Address - Street 1:423 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5964
Practice Address - Country:US
Practice Address - Phone:316-206-3636
Practice Address - Fax:316-869-2277
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-02699225X00000X, 225XP0200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888091300Medicaid
FL892178400Medicaid