Provider Demographics
NPI:1427614593
Name:PETERMAN, KRISTA KAYE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAYE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7059 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-9101
Mailing Address - Country:US
Mailing Address - Phone:440-226-7892
Mailing Address - Fax:
Practice Address - Street 1:7059 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-9101
Practice Address - Country:US
Practice Address - Phone:440-226-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician