Provider Demographics
NPI:1437218989
Name:LUNDSTEN, KRISTIN ELANA (OT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELANA
Last Name:LUNDSTEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6714
Mailing Address - Country:US
Mailing Address - Phone:617-786-8811
Mailing Address - Fax:617-786-8877
Practice Address - Street 1:5 MAUDE TER
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2413
Practice Address - Country:US
Practice Address - Phone:609-652-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8362225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist