Provider Demographics
NPI:1851641138
Name:HUSE, KRISTY M (MOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:M
Last Name:HUSE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAIRD LN
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-7568
Mailing Address - Country:US
Mailing Address - Phone:815-432-2051
Mailing Address - Fax:815-432-2069
Practice Address - Street 1:200 LAIRD LN
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-7568
Practice Address - Country:US
Practice Address - Phone:815-432-2051
Practice Address - Fax:815-432-2069
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008957225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation