Provider Demographics
NPI:1912031782
Name:BOOTS, KRISTINA M (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:BOOTS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5195 S 850 W
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IN
Mailing Address - Zip Code:46747-9732
Mailing Address - Country:US
Mailing Address - Phone:260-475-1096
Mailing Address - Fax:260-475-1096
Practice Address - Street 1:5195 S 850 W
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:IN
Practice Address - Zip Code:46747-9732
Practice Address - Country:US
Practice Address - Phone:260-475-1096
Practice Address - Fax:260-475-1096
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004082A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist