Provider Demographics
NPI:1144419565
Name:CASTRO, KRISTEN RACHELLE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RACHELLE
Last Name:CASTRO
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 1:1635 PLUTO RD
Mailing Address - Street 2:
Mailing Address - City:SHADY SPRING
Mailing Address - State:WV
Mailing Address - Zip Code:25918-8029
Mailing Address - Country:US
Mailing Address - Phone:562-253-5201
Mailing Address - Fax:
Practice Address - Street 1:315 MANCHESTER CT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-4263
Practice Address - Country:US
Practice Address - Phone:562-253-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1351225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist