Provider Demographics
NPI:1225491996
Name:LAW, KRISTIN (OTR/L, CLT, WCC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:OTR/L, CLT, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 EASTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2069
Mailing Address - Country:US
Mailing Address - Phone:215-659-1137
Mailing Address - Fax:215-659-1147
Practice Address - Street 1:709 EASTON RD
Practice Address - Street 2:SUITE 1 SOUTH
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2069
Practice Address - Country:US
Practice Address - Phone:215-659-1137
Practice Address - Fax:215-659-1147
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103136373-0001Medicaid
PA533559ZWTSMedicare PIN