Provider Demographics
NPI:1316063910
Name:ANDERSON-VORPAHL, KRISTIN (OTR, MPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ANDERSON-VORPAHL
Suffix:
Gender:F
Credentials:OTR, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 SHADOW RIDGE WAY
Mailing Address - Street 2:#3
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7610
Mailing Address - Country:US
Mailing Address - Phone:920-337-1398
Mailing Address - Fax:
Practice Address - Street 1:1142 ORLANDO DR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9484
Practice Address - Country:US
Practice Address - Phone:920-339-0700
Practice Address - Fax:920-330-0278
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10587-024225100000X
WI4253-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist