Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | 9081 | NC |
NPI | 1013336809 |
---|---|
Provider Name | Kristen Kratovil |
First Address | Raleigh, NC 27609-4380 |
Second Address | Raleigh, NC 27615-3071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 13/11/2017 |