Provider Demographics
NPI:1356686323
Name:MASTRIANNA, KRISTEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MASTRIANNA
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 1:850 MIX AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2102
Mailing Address - Country:US
Mailing Address - Phone:203-281-3500
Mailing Address - Fax:
Practice Address - Street 1:850 MIX AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2102
Practice Address - Country:US
Practice Address - Phone:203-281-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001167224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant