Provider Demographics
NPI:1114448834
Name:EKELUND, KIRSTEN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:EKELUND
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 1:196 RIVEREDGE RD
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2752
Mailing Address - Country:US
Mailing Address - Phone:917-612-9172
Mailing Address - Fax:
Practice Address - Street 1:196 RIVEREDGE RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-2752
Practice Address - Country:US
Practice Address - Phone:917-612-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
345266OtherNBCOT
NY008742-1OtherNYS COTA REGISTRATION