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General NPI Number Information
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NPI Number | 1881893675
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Entity Type | Individual
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Provider Name | KRISTINE SOARES
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Gender | Female
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 220 N SYKES CREEK PKWY STE 300
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3490
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Country | US
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Telephone | 321-459-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 653 ANGELA LN
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City | TITUSVILLE
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State | FL
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Zip | 32796-3902
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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