Provider Demographics
NPI:1245761618
Name:HENNER, KRISTY LYNNE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNNE
Last Name:HENNER
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BECKETT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1732
Mailing Address - Country:US
Mailing Address - Phone:856-467-3421
Mailing Address - Fax:856-467-5731
Practice Address - Street 1:520 BECKETT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:856-467-5731
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00774000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist