Provider Demographics
NPI:1649689894
Name:WHITTINGTON, KRISTINE KAORU (ATC, SCAT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:KAORU
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 ZIMALCREST DR APT 214
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6565
Mailing Address - Country:US
Mailing Address - Phone:478-230-0454
Mailing Address - Fax:
Practice Address - Street 1:716 ZIMALCREST DR APT 214
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6565
Practice Address - Country:US
Practice Address - Phone:478-230-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer