Provider Demographics
NPI:1457647240
Name:MCCONNELL, KRISTINA NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NICOLE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:NICOLE
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4631 WHITMAN LN SE STE D
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2250
Mailing Address - Country:US
Mailing Address - Phone:360-338-0181
Mailing Address - Fax:360-338-0257
Practice Address - Street 1:3901 CAPITAL MALL DR SW STE D
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8654
Practice Address - Country:US
Practice Address - Phone:360-709-6221
Practice Address - Fax:360-359-4727
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60976639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist