Provider Demographics
NPI:1598034035
Name:DELONG, CRISTIN MAE (COTA/L)
Entity type:Individual
Prefix:
First Name:CRISTIN
Middle Name:MAE
Last Name:DELONG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20288 HIGHWAY 15 N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-5684
Mailing Address - Country:US
Mailing Address - Phone:320-587-2326
Mailing Address - Fax:
Practice Address - Street 1:20288 HIGHWAY 15 N
Practice Address - Street 2:SUITE 100
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-5684
Practice Address - Country:US
Practice Address - Phone:320-587-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201283224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant