Provider Demographics
NPI:1215002886
Name:ALLEN, KRISTEN (ATC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ANSELM TER
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3106
Mailing Address - Country:US
Mailing Address - Phone:617-552-1045
Mailing Address - Fax:617-552-2392
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:124 CONTE FORUM, BOSTON COLLEGE
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3800
Practice Address - Country:US
Practice Address - Phone:617-552-1045
Practice Address - Fax:617-552-2392
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist