Healthcare Provider Details

I. General information

NPI: 1326817149
Provider Name (Legal Business Name): KRISTEN ANN HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8651 HILLTOP DR
BYRON IL
61010-9787
US

IV. Provider business mailing address

8651 HILLTOP DR
BYRON IL
61010-9787
US

V. Phone/Fax

Practice location:
  • Phone: 815-677-0909
  • Fax:
Mailing address:
  • Phone: 815-677-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number057.004864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: