Provider Demographics
NPI:1184434938
Name:MAHENDRA, KRISTIN MURAN (OT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MURAN
Last Name:MAHENDRA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LOUIS
Other - Last Name:MURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2007 WOOD MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8402
Mailing Address - Country:US
Mailing Address - Phone:314-277-3103
Mailing Address - Fax:
Practice Address - Street 1:2007 WOOD MANOR WAY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-8402
Practice Address - Country:US
Practice Address - Phone:314-277-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist