Healthcare Provider Details

I. General information

NPI: 1386788297
Provider Name (Legal Business Name): KRISTEN WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEAR CORBITT RD
BEAR DE
19701-1323
US

IV. Provider business mailing address

19 CATHERINE CT
BEAR DE
19701-2298
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberU20000823
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: