MEDICARE: KRISTIN WOOTEN PC, CR, MA

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
1	101YM0800X	Mental Health Counselor	C1300308	OH

General Provider Information

NPI Number	:	1598189474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN WOOTEN PC, CR, MA

Provider Business Mailing Address
First Line	:	7967 MILLWHEEL WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2016
Country	:	US
Telephone Number	:	937-404-1084
Fax Number	:

Provider Business Practice Location Address
First Line	:	10979 REED HARTMAN HWY
Second Line	:
City	:	BLUE ASH
State	:	OH
Zip	:	45242-2800
Country	:	US
Telephone Number	:	937-404-1084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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