Provider Demographics
NPI:1225484959
Name:RUSSELL, KRISTEN RYAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:RYAN
Last Name:RUSSELL
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 1:1185 7TH AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2778
Mailing Address - Country:US
Mailing Address - Phone:269-757-2176
Mailing Address - Fax:
Practice Address - Street 1:WINDSOR GARDENS CENTER OF REHABILITATION
Practice Address - Street 2:637 E ROMIE LN
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-424-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011518225X00000X
CA18816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist