Provider Demographics
NPI:1053749077
Name:REPNIK, KRISTIN (MOT/OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:REPNIK
Suffix:
Gender:F
Credentials:MOT/OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 NE MALLORY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2321
Mailing Address - Country:US
Mailing Address - Phone:503-975-5710
Mailing Address - Fax:
Practice Address - Street 1:6905 NE MALLORY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-2321
Practice Address - Country:US
Practice Address - Phone:503-975-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR310667225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology