Provider Demographics
NPI:1245596683
Name:PAUL, KRISTIN (COTA/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18210 EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-5905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4027 N FRANCISCO AVE
Practice Address - Street 2:#1S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2601
Practice Address - Country:US
Practice Address - Phone:773-263-6981
Practice Address - Fax:773-681-7233
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
057-002725225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics