Provider Demographics
NPI:1558708438
Name:MCDUFFEE, KRISTA (OTA)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MCDUFFEE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E WISCONSIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4865
Mailing Address - Country:US
Mailing Address - Phone:920-750-8468
Mailing Address - Fax:920-574-2045
Practice Address - Street 1:510 E WISCONSIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4865
Practice Address - Country:US
Practice Address - Phone:920-750-8468
Practice Address - Fax:920-574-2045
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant