Provider Demographics
NPI:1306118203
Name:GOLISZEK, KRISTIN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:GOLISZEK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MCKILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:777 MARYVALE DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2712
Mailing Address - Country:US
Mailing Address - Phone:716-677-9515
Mailing Address - Fax:
Practice Address - Street 1:777 MARYVALE DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2712
Practice Address - Country:US
Practice Address - Phone:716-677-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017203225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics