Provider Demographics
NPI:1659685600
Name:WEIN, KRISTA M (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:WEIN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2720
Mailing Address - Country:US
Mailing Address - Phone:414-937-2074
Mailing Address - Fax:
Practice Address - Street 1:1060 N 115TH ST
Practice Address - Street 2:APT 404
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3437
Practice Address - Country:US
Practice Address - Phone:414-937-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4869026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist