Provider Demographics
NPI:1124452727
Name:ANDERSON, KRISTYN ANN
Entity type:Individual
Prefix:MS
First Name:KRISTYN
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:ANN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3417 S AMMONS ST
Mailing Address - Street 2:#25-5
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-4925
Mailing Address - Country:US
Mailing Address - Phone:303-985-8992
Mailing Address - Fax:
Practice Address - Street 1:3417 S AMMONS ST
Practice Address - Street 2:#25-5
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4925
Practice Address - Country:US
Practice Address - Phone:303-985-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist