Provider Demographics
NPI:1437379716
Name:DEEKEN, KRISTINE KAY (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAY
Last Name:DEEKEN
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 1:6422 CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9774
Mailing Address - Country:US
Mailing Address - Phone:330-825-2538
Mailing Address - Fax:
Practice Address - Street 1:6422 CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-9774
Practice Address - Country:US
Practice Address - Phone:330-825-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4239225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist