Provider Demographics
NPI:1851066815
Name:TUFTS, KRISTINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:TUFTS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15349 MCQUISTON LN
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9604
Mailing Address - Country:US
Mailing Address - Phone:530-613-2839
Mailing Address - Fax:
Practice Address - Street 1:1101 SECRET RAVINE PKWY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4097
Practice Address - Country:US
Practice Address - Phone:916-890-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18988225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist