Provider Demographics
NPI:1508086349
Name:VANHISE, KRISTLE
Entity Type:Individual
Prefix:
First Name:KRISTLE
Middle Name:
Last Name:VANHISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRIGGS ISLAND CV
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5493
Mailing Address - Country:US
Mailing Address - Phone:207-893-1545
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:PHYSICAL REHABILITATION DEPT
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5664
Practice Address - Country:US
Practice Address - Phone:207-743-1562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist