Provider Demographics
NPI:1689903577
Name:MADDOCK, KRISTI N (MS, OT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:N
Last Name:MADDOCK
Suffix:
Gender:F
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-3126
Mailing Address - Country:US
Mailing Address - Phone:406-989-2977
Mailing Address - Fax:
Practice Address - Street 1:303 OAK ST
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-3126
Practice Address - Country:US
Practice Address - Phone:406-989-2977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist