Provider Demographics
NPI:1427085489
Name:RUDOLF, KRISTI JO (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:JO
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:JO
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4804 37TH AVE N
Mailing Address - Street 2:
Mailing Address - City:REILES ACRES
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5438
Mailing Address - Country:US
Mailing Address - Phone:701-306-1817
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:130R
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:701-239-3721
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1053141224Z00000X
ND832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant