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NPI Code Detail

MEDICARE: MRS. KRISTIN MARIE MUNGOVAN OTR

MEDICARE: MRS. KRISTIN MARIE MUNGOVAN OTR
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 Therapist1508026WI

General Provider Information

NPI Number : 1831290493
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN MARIE MUNGOVAN OTR
Provider Business Mailing Address
First Line : 2727 W. MITCHELL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2259
Country : US
Telephone Number : 414-383-3699
Fax Number : 414-383-3866
Provider Business Practice Location Address
First Line : 2727 W. MITCHELL ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2259
Country : US
Telephone Number : 414-383-3699
Fax Number : 414-383-3866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 03/09/2009

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Directions to “ MRS. KRISTIN MARIE MUNGOVAN OTR” Practice Location

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