Provider Demographics
NPI:1427173202
Name:CROUTWORST, KRISTIN MAIER (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MAIER
Last Name:CROUTWORST
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:BEACH
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:381 PHILLIPS HILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05342-9523
Mailing Address - Country:US
Mailing Address - Phone:802-368-2619
Mailing Address - Fax:
Practice Address - Street 1:175 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2712
Practice Address - Country:US
Practice Address - Phone:413-664-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist