Provider Demographics
NPI:1477971398
Name:HALSTED, KRISTEN LYNNE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNNE
Last Name:HALSTED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNNE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N MAIN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1004
Mailing Address - Country:US
Mailing Address - Phone:417-466-3711
Mailing Address - Fax:417-461-5765
Practice Address - Street 1:600 N MAIN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712-1004
Practice Address - Country:US
Practice Address - Phone:417-466-3711
Practice Address - Fax:417-461-5765
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist