Provider Demographics
NPI:1881922383
Name:GEIS, KRISTIN M (OT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:GEIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:DOROZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2422 BEN HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-4894
Mailing Address - Country:US
Mailing Address - Phone:618-416-1915
Mailing Address - Fax:
Practice Address - Street 1:2422 BEN HOGAN DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-4894
Practice Address - Country:US
Practice Address - Phone:618-416-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056008339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist