Provider Demographics
NPI:1720792211
Name:DIK, KRISTINA LEE (OT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE
Last Name:DIK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:LEE
Other - Last Name:DIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:317 RUNAWAY BAY CIR APT 2B
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8032
Mailing Address - Country:US
Mailing Address - Phone:810-288-5726
Mailing Address - Fax:
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2499
Practice Address - Country:US
Practice Address - Phone:574-523-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31007670A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist