Provider Demographics
NPI:1942707518
Name:ZAJDEL, KRISTIN NICOLE (LMT, EMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:ZAJDEL
Suffix:
Gender:F
Credentials:LMT, EMT
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:SMILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT
Mailing Address - Street 1:8421 NORTHERN DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7216
Mailing Address - Country:US
Mailing Address - Phone:317-524-8658
Mailing Address - Fax:
Practice Address - Street 1:6319 E US HIGHWAY 36 STE 5
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6210
Practice Address - Country:US
Practice Address - Phone:317-943-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21806464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist