Provider Demographics
NPI:1275715401
Name:MACCHIAROLO, KRISTEN IRENE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:IRENE
Last Name:MACCHIAROLO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2352
Mailing Address - Country:US
Mailing Address - Phone:573-642-0202
Mailing Address - Fax:
Practice Address - Street 1:1132 CAPRICORN BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983
Practice Address - Country:US
Practice Address - Phone:941-286-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12587224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1275715401Medicaid