Provider Demographics
NPI:1750827978
Name:COORLAS, KRISTIN FURLA (MED)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:FURLA
Last Name:COORLAS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ELAINE
Other - Last Name:FURLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2916 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6404
Mailing Address - Country:US
Mailing Address - Phone:847-721-4138
Mailing Address - Fax:
Practice Address - Street 1:2916 FLORAL DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6404
Practice Address - Country:US
Practice Address - Phone:847-721-4138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist