Provider Demographics
NPI:1053456863
Name:SASONOFF, KRISTEN MARIE (ATC, LAT, RAA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARIE
Last Name:SASONOFF
Suffix:
Gender:F
Credentials:ATC, LAT, RAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SPRUCE ST
Mailing Address - Street 2:APT 1
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2031
Mailing Address - Country:US
Mailing Address - Phone:508-381-1540
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-2574
Practice Address - Country:US
Practice Address - Phone:781-821-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer