Provider Demographics
NPI:1932491693
Name:OLDREAD, KIRSTEN FRASER (RMT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:FRASER
Last Name:OLDREAD
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:MEREDITH
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RMT
Mailing Address - Street 1:PO BOX 1962
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1962
Mailing Address - Country:US
Mailing Address - Phone:970-901-2429
Mailing Address - Fax:
Practice Address - Street 1:120 ELK AVE
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224
Practice Address - Country:US
Practice Address - Phone:970-901-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2033225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist