Provider Demographics
NPI:1073640405
Name:ABBOUD, KRISTIN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ABBOUD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISITN
Other - Middle Name:
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3179 BRAVERTON ST
Mailing Address - Street 2:STE 201
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2667
Mailing Address - Country:US
Mailing Address - Phone:410-295-8900
Mailing Address - Fax:410-280-4701
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:STE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-295-8900
Practice Address - Fax:410-280-4701
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007012225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist