Healthcare Provider Details

I. General information

NPI: 1710894662
Provider Name (Legal Business Name): KRISTIN OCONNOR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 S CALUMET RD
CHESTERTON IN
46304-3301
US

IV. Provider business mailing address

3125 CALUMET AVE STE 8
VALPARAISO IN
46383-2070
US

V. Phone/Fax

Practice location:
  • Phone: 219-695-8875
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: