Provider Demographics
NPI:1558647602
Name:ENSIGN, KRISTINE ANN (AT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:ENSIGN
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 RICHLAND AVENUE
Mailing Address - Street 2:OHIO UNIVERSITY, GROVER CENTER E187
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:407-593-9497
Mailing Address - Fax:
Practice Address - Street 1:53 RICHLAND AVENUE
Practice Address - Street 2:OHIO UNIVERSITY, GROVER CENTER E187
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:407-593-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer