=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285838029
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIE ALICE JEWELL OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 BLUEBERRY LANE LACONIA CENTER
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-524-3340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 WOODLAND DR
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03220-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-528-9490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 1449
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------