Provider Demographics
NPI:1265637102
Name:DEETER, KRISTY ANN (OTRL)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:DEETER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TOWER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:17980
Mailing Address - Country:US
Mailing Address - Phone:717-647-0427
Mailing Address - Fax:
Practice Address - Street 1:7540 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:888-543-2289
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007300L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist