Provider Demographics
NPI:1285855221
Name:WITTENBROOK, KRISTIN LEE (MA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:WITTENBROOK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55740 BEL HVN
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-9649
Mailing Address - Country:US
Mailing Address - Phone:740-579-1841
Mailing Address - Fax:
Practice Address - Street 1:55740 BEL HVN
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-9649
Practice Address - Country:US
Practice Address - Phone:740-579-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2024-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle