Individual
KRISTINE HOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4700 MEMORIAL DR, BELLEVILLE, IL 62226-5373
(618) 257-5758
Mailing address
1530 PEACH ORCHARD LN, O FALLON, IL 62269-6636
(618) 628-0261
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-007501
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001415008
BCBS OF IL
IL
01
—
5330619
AETNA
—
Enumeration date
01/06/2007
Last updated
09/06/2012
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