Provider Demographics
NPI:1619005642
Name:SNOW, KRISTA K (MS)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:K
Last Name:SNOW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3904
Mailing Address - Country:US
Mailing Address - Phone:660-626-1400
Mailing Address - Fax:660-665-3281
Practice Address - Street 1:1901 E HAMILTON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3904
Practice Address - Country:US
Practice Address - Phone:660-626-1400
Practice Address - Fax:660-665-3281
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist