Provider Demographics
NPI:1831820315
Name:NEEDHAM, KRISTINA ANN
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 S COUNTY ROAD 250 W
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9224
Mailing Address - Country:US
Mailing Address - Phone:317-966-9610
Mailing Address - Fax:
Practice Address - Street 1:3330 S COUNTY ROAD 250 W
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9224
Practice Address - Country:US
Practice Address - Phone:317-966-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist