Provider Demographics
NPI:1467153015
Name:SPANGLER, KRISTINA KATE (COTA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KATE
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1911
Mailing Address - Country:US
Mailing Address - Phone:779-861-3882
Mailing Address - Fax:
Practice Address - Street 1:502 N STATE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN GROVE
Practice Address - State:IL
Practice Address - Zip Code:61031-9773
Practice Address - Country:US
Practice Address - Phone:815-456-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004828224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant