Basic Information
| Provider Information | |||||||||
| NPI: | 1417518838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLLNY | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 S WILLOW ST STE 128 | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031035705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3155 AVENUE C | ||||||||
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| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066568818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTP-OT-LIC-6855 | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 46TR00879500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.