Provider Demographics
NPI:1326264243
Name:HANLON, KRISTI LYNN (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:LYNN
Last Name:HANLON
Suffix:
Gender:F
Credentials:COTA L
Other - Prefix:MISS
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:BENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA L
Mailing Address - Street 1:1820 FORREST ROAD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6117
Mailing Address - Country:US
Mailing Address - Phone:410-668-1194
Mailing Address - Fax:
Practice Address - Street 1:515 BRIGHTFIELD ROAD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093
Practice Address - Country:US
Practice Address - Phone:410-296-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00548224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant