Provider Demographics
NPI:1285455683
Name:MUSACCO, KRISTEN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MUSACCO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N CITY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4411
Mailing Address - Country:US
Mailing Address - Phone:661-302-5607
Mailing Address - Fax:
Practice Address - Street 1:5651 PALMER WAY STE D
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7244
Practice Address - Country:US
Practice Address - Phone:760-918-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT24499225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist