Basic Information
| Provider Information | |||||||||
| NPI: | 1013109917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCHWITZ | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | GAYE | ||||||||
| NamePrefix: | MS. | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HACKNEY | ||||||||
| OtherFirstName: | KRISTY | ||||||||
| OtherMiddleName: | GAYE | ||||||||
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| OtherCredential: | COTA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 221 W MOORE ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549231551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203797413 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7540 N 19H AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850219958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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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 | 224Z00000X | 267 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.