Provider Demographics
NPI:1396995619
Name:BREON, KRISTA RENEE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:RENEE
Last Name:BREON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:311 WARRICK STREET
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851-0614
Mailing Address - Country:US
Mailing Address - Phone:814-272-2105
Mailing Address - Fax:814-867-7138
Practice Address - Street 1:5500 BROOKTREE ROAD
Practice Address - Street 2:SUITE 102 REHABCARE
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9260
Practice Address - Country:US
Practice Address - Phone:814-272-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist