Provider Demographics
NPI:1871343772
Name:VITALI, KRISTIN RENEE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:VITALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9746
Mailing Address - Country:US
Mailing Address - Phone:937-626-0329
Mailing Address - Fax:
Practice Address - Street 1:585 N STATE ROUTE 741
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-3313
Practice Address - Country:US
Practice Address - Phone:513-932-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA004308224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant