Provider Demographics
NPI:1437496445
Name:STEWART, KRISTEN K (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:K
Last Name:STEWART
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CRESCENT ST APT 412
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-3498
Mailing Address - Country:US
Mailing Address - Phone:315-408-1337
Mailing Address - Fax:
Practice Address - Street 1:185 CRESCENT ST APT 412
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-3498
Practice Address - Country:US
Practice Address - Phone:315-408-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17408225X00000X
MA13414225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist