Individual
KRISTEN RENEE AX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3060 SE STARK ST, PORTLAND, OR 97214-3053
(503) 535-4700
Mailing address
3021 NE GLISAN ST APT 105, PORTLAND, OR 97232-3286
(757) 773-1158
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
06/21/2018
Last updated
06/21/2018
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