Provider Demographics
NPI:1912056946
Name:BROWN, KRISTINA (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-7248
Mailing Address - Country:US
Mailing Address - Phone:607-742-9738
Mailing Address - Fax:607-739-2610
Practice Address - Street 1:25 SUTTON RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-7248
Practice Address - Country:US
Practice Address - Phone:607-742-9738
Practice Address - Fax:607-739-2610
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012386-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist