Provider Demographics
NPI:1457190761
Name:KRUMANAKER, KRISTEN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KRUMANAKER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-8201
Mailing Address - Country:US
Mailing Address - Phone:937-215-1822
Mailing Address - Fax:
Practice Address - Street 1:726 HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-8201
Practice Address - Country:US
Practice Address - Phone:937-215-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25341225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist