Provider Demographics
NPI:1831995588
Name:EBERHARDT, KRISTEN L
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:EBERHARDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 GOLF COURSE DR N
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9173
Mailing Address - Country:US
Mailing Address - Phone:630-248-6343
Mailing Address - Fax:630-554-6778
Practice Address - Street 1:8001 GOLF COURSE DR N
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9173
Practice Address - Country:US
Practice Address - Phone:630-248-6343
Practice Address - Fax:630-554-6778
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant