Provider Demographics
NPI:1467681940
Name:STREET, KRISTEN E (OT/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:STREET
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VAN VOORHIS RD
Mailing Address - Street 2:APT. E
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3443
Mailing Address - Country:US
Mailing Address - Phone:304-381-2345
Mailing Address - Fax:
Practice Address - Street 1:1200 VAN VOORHIS RD
Practice Address - Street 2:APT. E
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3443
Practice Address - Country:US
Practice Address - Phone:304-381-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1153225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist