Provider Demographics
NPI:1396114575
Name:JELSON, KRISTIN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:JELSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 TESNOW RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9110
Mailing Address - Country:US
Mailing Address - Phone:585-698-5775
Mailing Address - Fax:
Practice Address - Street 1:7950 TESNOW RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-9110
Practice Address - Country:US
Practice Address - Phone:585-698-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013387-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist