Provider Demographics
NPI:1104942283
Name:ZABALLERO, KRISTIN TOMBOC (OTRL)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:TOMBOC
Last Name:ZABALLERO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MCMULLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3058
Mailing Address - Country:US
Mailing Address - Phone:302-299-9179
Mailing Address - Fax:
Practice Address - Street 1:1920 OLD SPRINGVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5858
Practice Address - Country:US
Practice Address - Phone:800-254-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000895225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist