Provider Demographics
NPI:1962565630
Name:FRIESEN, KRISTINE RUTH (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:RUTH
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 CHAMPA ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2789
Mailing Address - Country:US
Mailing Address - Phone:303-358-6538
Mailing Address - Fax:
Practice Address - Street 1:2921 CHAMPA ST
Practice Address - Street 2:UNIT A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2789
Practice Address - Country:US
Practice Address - Phone:303-358-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97034240Medicaid