Provider Demographics
NPI:1407007719
Name:SUDA, KRISTEN ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ANN
Last Name:SUDA
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 1:5 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-9114
Mailing Address - Country:US
Mailing Address - Phone:570-743-2415
Mailing Address - Fax:570-743-2415
Practice Address - Street 1:5 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9114
Practice Address - Country:US
Practice Address - Phone:570-743-2415
Practice Address - Fax:570-743-2415
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003634L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist