Provider Demographics
NPI:1760440002
Name:AIMONE, KRISTINA MARIE (OT)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MARIE
Last Name:AIMONE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411169
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-1169
Mailing Address - Country:US
Mailing Address - Phone:888-304-1258
Mailing Address - Fax:
Practice Address - Street 1:10033 WICKER AVE STE 7&8
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8776
Practice Address - Country:US
Practice Address - Phone:219-213-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004161A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200686330Medicaid