Provider Demographics
NPI:1285838029
Name:JEWELL, KRISTIE ALICE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:ALICE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03220-3836
Mailing Address - Country:US
Mailing Address - Phone:603-528-9490
Mailing Address - Fax:
Practice Address - Street 1:175 BLUEBERRY LANE
Practice Address - Street 2:LACONIA CENTER
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist