Provider Demographics
NPI:1912417882
Name:O'CONNOR, KRISTIN MARIE ALTHEA
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE ALTHEA
Last Name:O'CONNOR
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 1:171 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2221
Mailing Address - Country:US
Mailing Address - Phone:541-517-2976
Mailing Address - Fax:
Practice Address - Street 1:171 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2221
Practice Address - Country:US
Practice Address - Phone:541-517-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR182076171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist