Provider Demographics
NPI:1578195392
Name:GRAHAME, KRISTINA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:GRAHAME
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TAYLOR BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2287
Mailing Address - Country:US
Mailing Address - Phone:925-692-1160
Mailing Address - Fax:925-692-5850
Practice Address - Street 1:399 TAYLOR BLVD STE 208
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2287
Practice Address - Country:US
Practice Address - Phone:925-692-1160
Practice Address - Fax:925-692-5850
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist