Provider Demographics
NPI:1457364101
Name:DUHAMEL, KRISTEN M (MED, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:DUHAMEL
Suffix:
Gender:F
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROVIDENCE COLLEGE ALUMNI HALL
Mailing Address - Street 2:549 RIVER AVENUE
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02918-0001
Mailing Address - Country:US
Mailing Address - Phone:401-865-2260
Mailing Address - Fax:401-865-2965
Practice Address - Street 1:PROVIDENCE COLLEGE ALUMNI HALL
Practice Address - Street 2:549 RIVER AVENUE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02918-0001
Practice Address - Country:US
Practice Address - Phone:401-865-2260
Practice Address - Fax:401-865-2965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT001842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer