Provider Demographics
NPI:1518343508
Name:AMIS, KRISTOPHER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:
Last Name:AMIS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:AMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:ROOM B2021
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-0411
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:ROOM B2021
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9056225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation