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NPI Code Detail

MEDICARE: KRISTIN LEIGH KLENNERT

MEDICARE: KRISTIN LEIGH KLENNERT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist1064WV

General Provider Information

NPI Number : 1427173293
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN LEIGH KLENNERT
Provider Business Mailing Address
First Line : 2066 PINECREST DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-8031
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 161 BAKERS RIDGE RD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-1459
Country : US
Telephone Number : 304-285-0692
Fax Number : 304-285-0693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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Directions to “ KRISTIN LEIGH KLENNERT ” Practice Location

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