Healthcare Provider Details

I. General information

NPI: 1609337195
Provider Name (Legal Business Name): KRISTEN ALEXIS YAMNITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 GRAND AVE
PERRYVILLE MO
63775-1673
US

IV. Provider business mailing address

932 GRAND AVE
PERRYVILLE MO
63775-1673
US

V. Phone/Fax

Practice location:
  • Phone: 314-450-0579
  • Fax:
Mailing address:
  • Phone: 314-450-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: