Provider Demographics
NPI:1619641248
Name:BANNING, KRISTINA (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BANNING
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 1:10 DILL CT
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-7519
Mailing Address - Country:US
Mailing Address - Phone:908-309-9067
Mailing Address - Fax:
Practice Address - Street 1:971 ELK MILLS RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-3805
Practice Address - Country:US
Practice Address - Phone:410-996-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0002166225X00000X
MD08967225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist