Provider Demographics
NPI:1013256239
Name:WILLIS, KRISTIN LEANN (BS)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEANN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 COUNTY STREET 2955
Mailing Address - Street 2:
Mailing Address - City:TUTTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73089-3138
Mailing Address - Country:US
Mailing Address - Phone:314-435-2339
Mailing Address - Fax:
Practice Address - Street 1:1175 COUNTY STREET 2955
Practice Address - Street 2:
Practice Address - City:TUTTLE
Practice Address - State:OK
Practice Address - Zip Code:73089-3138
Practice Address - Country:US
Practice Address - Phone:314-435-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor