Provider Demographics
NPI:1043738545
Name:LUNDQUIST, KRYSTA (OT)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRYSTA
Other - Middle Name:
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:233 MIDDLE STREET
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:781-843-1860
Mailing Address - Fax:
Practice Address - Street 1:233 MIDDLE STREET
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-843-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist