Provider Demographics
NPI:1568597276
Name:TITUS, KRISTIN LAURA (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LAURA
Last Name:TITUS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9456
Mailing Address - Country:US
Mailing Address - Phone:919-451-9636
Mailing Address - Fax:
Practice Address - Street 1:2805 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9634
Practice Address - Country:US
Practice Address - Phone:919-451-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5845225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301872Medicaid