Individual
KRISTIE LYNNE PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
106 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 236-7588
Mailing address
106 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 236-7588
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001415008
BLUE CROSS BLUE SHIELD IL
IL
01
—
5330619
AETNA
—
Enumeration date
09/26/2007
Last updated
09/26/2007
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