Provider Demographics
NPI:1396884821
Name:PON, KRISTEN ESTELLE TOWNSEND (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ESTELLE TOWNSEND
Last Name:PON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ESTELLE
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1886 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-4711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1886 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-4711
Practice Address - Country:US
Practice Address - Phone:706-955-2639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004168225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist