Provider Demographics
NPI:1184332710
Name:NGUYEN, KRISTINE MINH DUYEN (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MINH DUYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 TYVOLA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2964
Mailing Address - Country:US
Mailing Address - Phone:704-299-5217
Mailing Address - Fax:
Practice Address - Street 1:160 RIVER BEND DR STE 104
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-9371
Practice Address - Country:US
Practice Address - Phone:828-212-5098
Practice Address - Fax:828-313-0376
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15492225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist