Provider Demographics
NPI:1992771703
Name:SIEGENTHALER, KRISTINE GRUNEWALD (OTRL/CHT/CLT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:GRUNEWALD
Last Name:SIEGENTHALER
Suffix:
Gender:F
Credentials:OTRL/CHT/CLT
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 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5052
Mailing Address - Country:US
Mailing Address - Phone:918-756-3330
Mailing Address - Fax:918-756-3332
Practice Address - Street 1:114 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447
Practice Address - Country:US
Practice Address - Phone:918-756-3330
Practice Address - Fax:918-756-3332
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT 735225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100645450BMedicaid
OKOKA101839Medicare PIN