Provider Demographics
NPI:1376858167
Name:FLOOD, KRISTIN L (COTA)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:L
Last Name:FLOOD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:L
Other - Last Name:KARBON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5219 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-7468
Mailing Address - Country:US
Mailing Address - Phone:262-653-0850
Mailing Address - Fax:262-653-0853
Practice Address - Street 1:5219 88TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-7468
Practice Address - Country:US
Practice Address - Phone:262-653-0850
Practice Address - Fax:262-653-0853
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2065027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant