Healthcare Provider Details

I. General information

NPI: 1336621101
Provider Name (Legal Business Name): KRISTIN STEWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 INDUSTRIAL WAY STE 10
ROCHESTER NH
03867-4291
US

IV. Provider business mailing address

113 CROSBY RD STE 1
DOVER NH
03820-4370
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax: 603-740-9179
Mailing address:
  • Phone: 603-516-9300
  • Fax: 603-740-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: