Provider Demographics
NPI:1023231065
Name:ECKERT, KRYSTAL DAWN (OTR)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DAWN
Last Name:ECKERT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9492
Mailing Address - Country:US
Mailing Address - Phone:812-683-2084
Mailing Address - Fax:
Practice Address - Street 1:313 POPLAR ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-2423
Practice Address - Country:US
Practice Address - Phone:812-295-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003106A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist