Provider Demographics
NPI:1669705950
Name:MANDLE, KRISTEN MARIE (MOT OTR/S)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:MANDLE
Suffix:
Gender:F
Credentials:MOT OTR/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7709
Mailing Address - Country:US
Mailing Address - Phone:563-421-3467
Mailing Address - Fax:563-421-3699
Practice Address - Street 1:2535 MAPLECREST RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7709
Practice Address - Country:US
Practice Address - Phone:563-421-3467
Practice Address - Fax:563-421-3699
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001912225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist