Provider Demographics
NPI:1588072805
Name:DICKINSON, KRISTINE LOUISE (OTR/L,CLT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:LOUISE
Last Name:DICKINSON
Suffix:
Gender:F
Credentials:OTR/L,CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4056
Mailing Address - Country:US
Mailing Address - Phone:314-495-8757
Mailing Address - Fax:
Practice Address - Street 1:9045 PATRICK DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4056
Practice Address - Country:US
Practice Address - Phone:314-495-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008033145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist