Provider Demographics
NPI:1518090471
Name:MAISANO, KRISTEN LEIGH (OTD, OTR/L, CPAM)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEIGH
Last Name:MAISANO
Suffix:
Gender:F
Credentials:OTD, OTR/L, CPAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 OLD CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5036
Mailing Address - Country:US
Mailing Address - Phone:570-313-3846
Mailing Address - Fax:
Practice Address - Street 1:6504 OLD CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5036
Practice Address - Country:US
Practice Address - Phone:570-313-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC009867225X00000X
VA0119006107225X00000X
DCOT010000828225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist