Provider Demographics
NPI:1811234420
Name:BINNICKER, KRISTIN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:BINNICKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:KANTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7608 CAMINO ABIERTO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6947
Mailing Address - Country:US
Mailing Address - Phone:480-794-0955
Mailing Address - Fax:
Practice Address - Street 1:700 5TH ST S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7764
Practice Address - Country:US
Practice Address - Phone:952-993-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11594OtherOCCUPATIONAL THERAPIST LICENSE NUMBER