Provider Demographics
NPI:1578951836
Name:BOZARD, KRISTEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BOZARD
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 WATERSIDE POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7227
Mailing Address - Country:US
Mailing Address - Phone:407-770-8657
Mailing Address - Fax:
Practice Address - Street 1:1809 E BROADWAY ST
Practice Address - Street 2:#122
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8597
Practice Address - Country:US
Practice Address - Phone:407-359-5693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07271225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist