Basic Information
Provider Information
NPI: 1982775771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THORPE
FirstName: KRISTEN
MiddleName: POLLARD
NamePrefix: MRS.
NameSuffix:  
Credential: MS, OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: POLLARD
OtherFirstName: KRISTEN
OtherMiddleName: ELAINE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1004 10TH ST
Address2:  
City: PORT ROYAL
State: SC
PostalCode: 299352310
CountryCode: US
TelephoneNumber: 8433109690
FaxNumber: 8003179690
Practice Location
Address1: 1004 10TH ST
Address2:  
City: PORT ROYAL
State: SC
PostalCode: 299352310
CountryCode: US
TelephoneNumber: 8433109690
FaxNumber: 8003179690
Other Information
ProviderEnumerationDate: 11/13/2006
LastUpdateDate: 02/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X2680SCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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