Provider Demographics
NPI:1356718936
Name:WEINERT-STEIN, KRISTYN (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:WEINERT-STEIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 GREY FOX RUN
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3393
Mailing Address - Country:US
Mailing Address - Phone:440-247-3786
Mailing Address - Fax:
Practice Address - Street 1:5500 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3114
Practice Address - Country:US
Practice Address - Phone:216-510-4719
Practice Address - Fax:216-510-4772
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT008837225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13624441OtherCAQH
OHATN: 163507Medicaid