Kristine Elizabeth Hettenhausen, OTR/L

Individual provider Active NPI Occupational Therapist · O Fallon, IL

NPI 1750520060 · NPPES record last updated Feb 10, 2009

Key facts

NPI
1750520060
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapist 225X00000X
License
056-005370 (IL)
Practice address
509 Haddington LN
O Fallon, IL 62269-4242
Phone
(618) 632-3234
NPI assigned
Feb 10, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
056-005370ILMDOccupational Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056-005370 IL Yes

Addresses

Primary practice location

509 Haddington LN
O Fallon, IL 62269-4242

Mailing address

509 Haddington LN
O Fallon, IL 62269-4242
Phone (618) 632-3234

Other providers in O Fallon, IL

All providers in O Fallon, IL · Occupational Therapist in Illinois

Sources for this page

Verify at the official NPI Registry.