Provider Demographics
NPI:1841553229
Name:DRURY, KRISTEN (ATC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DRURY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 HANNAH BLVD
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5384
Mailing Address - Country:US
Mailing Address - Phone:517-899-9838
Mailing Address - Fax:
Practice Address - Street 1:2900 HANNAH BLVD
Practice Address - Street 2:SUITE B-102
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5384
Practice Address - Country:US
Practice Address - Phone:517-899-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010005262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer