Provider Demographics
NPI:1821845280
Name:QUEEN, KRISTEN (OT/L)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 GOLDENLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:WHISPERING PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28327-0107
Mailing Address - Country:US
Mailing Address - Phone:662-871-0940
Mailing Address - Fax:
Practice Address - Street 1:482 GOLDENLEAF CIR
Practice Address - Street 2:
Practice Address - City:WHISPERING PINES
Practice Address - State:NC
Practice Address - Zip Code:28327-0107
Practice Address - Country:US
Practice Address - Phone:662-871-0940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation