Provider Demographics
NPI:1942409032
Name:SISK, KRISTINE A (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:A
Last Name:SISK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 E 76TH ST N UNIT NO117
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4026
Mailing Address - Country:US
Mailing Address - Phone:918-269-4128
Mailing Address - Fax:918-343-7491
Practice Address - Street 1:12899 E 76TH ST N UNIT NO117
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4026
Practice Address - Country:US
Practice Address - Phone:918-269-4128
Practice Address - Fax:918-343-7491
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK735224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant