Individual
KRISTEN LAURIE BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
153 SUMMER ST, PROVIDENCE, RI 02903-4011
(401) 276-4300
Mailing address
153 SUMMER ST, PROVIDENCE, RI 02903-4011
(401) 276-4300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 00994
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0614
NHP RI
RI
05
—
ES01788
—
RI
01
—
SB870
BC RI
RI
Enumeration date
07/23/2006
Last updated
08/19/2025
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