Provider Demographics
NPI:1871577486
Name:ERTEL, KRISTA PINTER (MOTR)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:PINTER
Last Name:ERTEL
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-4545
Mailing Address - Country:US
Mailing Address - Phone:940-224-2662
Mailing Address - Fax:
Practice Address - Street 1:2010 BRUSHY CREEK RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2614
Practice Address - Country:US
Practice Address - Phone:815-539-1409
Practice Address - Fax:815-539-1652
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111050225X00000X
IL056.007990225X00000X
NC6661225X00000X
SC4777225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084034OtherBLUE LINK #
TX8T1645OtherBCBS PROVIDER #
TX125138OtherSUPERIOR ID #
TX111050OtherHUMANA ID #