Provider Demographics
NPI:1497812259
Name:ERICKSON, KRISTINE PERNELLA (OT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:PERNELLA
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 JOHNS LAKE RD APT 1123
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6666
Mailing Address - Country:US
Mailing Address - Phone:321-297-2720
Mailing Address - Fax:
Practice Address - Street 1:3950 3RD ST N STE D
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-6123
Practice Address - Country:US
Practice Address - Phone:727-896-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11069225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics