Provider Demographics
NPI:1427226851
Name:KRISS, MARIANA ANGELA (OTR-L)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:ANGELA
Last Name:KRISS
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 1:21 WATEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4248
Mailing Address - Country:US
Mailing Address - Phone:860-677-2934
Mailing Address - Fax:860-938-2867
Practice Address - Street 1:21 WATEVILLE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4248
Practice Address - Country:US
Practice Address - Phone:860-677-2934
Practice Address - Fax:860-938-2867
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001975225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076585Medicare UPIN