Provider Demographics
NPI:1386811768
Name:PAINTER, KRISTY ANN (OTR)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:ANN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:ANN
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:200 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1393
Mailing Address - Country:US
Mailing Address - Phone:920-336-5680
Mailing Address - Fax:920-336-5882
Practice Address - Street 1:200 S 9TH ST
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1393
Practice Address - Country:US
Practice Address - Phone:920-336-5680
Practice Address - Fax:920-336-5882
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4612-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist