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NPI Code Detail

MEDICARE: MRS. KRISTIN MARIE DELFORGE

MEDICARE: MRS. KRISTIN MARIE DELFORGE
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 Therapist2397-026WI

General Provider Information

NPI Number : 1427289032
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN MARIE DELFORGE
Provider Business Mailing Address
First Line : 3137 RIDGEVIEW TER
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-1516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3137 RIDGEVIEW TER
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-1516
Country : US
Telephone Number : 763-689-5385
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2009
Last Update Date : 01/09/2015

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Directions to “ MRS. KRISTIN MARIE DELFORGE ” Practice Location

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