Kristine Kay Vasquez, OTR/L
Individual provider Active NPI Specialist · Williams, AZ
NPI 1801852306 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1801852306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 0411 (AZ)
- Practice address
- 122 S 3Rd St
Williams, AZ 86046-2404 - Phone
- (928) 635-1477
- Fax
- (928) 635-0143
- NPI assigned
- Apr 24, 2006
- 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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0411 | AZ | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 0411 | AZ | Yes |
Addresses
Primary practice location
122 S 3Rd St
Williams, AZ 86046-2404
Mailing address
222 S Golden Meadow TRL
Williams, AZ 86046-9625
Phone (928) 635-2042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AZ0293560 | Other | AZ | BCBS |
| 19033560 | Other | AZ | WORKER'S COMP |
| 771479 | Other | AZ | AHCCCS |
Other providers in Williams, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.