Provider Demographics
NPI:1134253248
Name:NITSCHKE, KRISTINA (MA OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:NITSCHKE
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:GERMANN
Other - Suffix:IX
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-952-5142
Mailing Address - Fax:701-952-1450
Practice Address - Street 1:701 3RD ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2963
Practice Address - Country:US
Practice Address - Phone:701-252-3850
Practice Address - Fax:701-952-5154
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462279Medicaid
ND54579Medicaid