Provider Demographics
NPI:1699983304
Name:MURRAY, KRISTINE JENNIFER (DT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:JENNIFER
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5912
Mailing Address - Country:US
Mailing Address - Phone:847-368-1748
Mailing Address - Fax:847-368-1749
Practice Address - Street 1:114 W FREMONT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5912
Practice Address - Country:US
Practice Address - Phone:847-368-1748
Practice Address - Fax:847-368-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILKM68200301POtherCREDENTIALING NUMBER