Individual
MRS. KRISTINA KAY WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT,OT/L
Contact information
Practice address
3050 MONTVALE DR SUITE A, SPRINGFIELD, IL 62704-9415
(217) 891-1524
Mailing address
4405 LYNHURST RD, SPRINGFIELD, IL 62711-7131
(217) 891-1524
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056008995
IL
225X00000X
Occupational Therapist
31004218A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200688260
—
IN
Enumeration date
03/15/2007
Last updated
06/25/2023
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