Provider Demographics
NPI:1699931899
Name:COBB, KRISTEN GREE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:GREE
Last Name:COBB
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:GREER
Other - Last Name:FREVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:211 RANGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-5901
Mailing Address - Country:US
Mailing Address - Phone:120-771-2732
Mailing Address - Fax:
Practice Address - Street 1:211 RANGE HILL RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-5901
Practice Address - Country:US
Practice Address - Phone:120-771-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist