Provider Demographics
NPI:1972905537
Name:DAVES, KRISTINA EATON (OT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:EATON
Last Name:DAVES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4449
Mailing Address - Country:US
Mailing Address - Phone:843-669-1188
Mailing Address - Fax:843-669-7144
Practice Address - Street 1:507 W CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4449
Practice Address - Country:US
Practice Address - Phone:843-669-1188
Practice Address - Fax:843-669-7144
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1731225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics