Provider Demographics
NPI:1558584524
Name:OVERSTREET, KRISTIE ANN (COTA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ANN
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 HAYDENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9767
Mailing Address - Country:US
Mailing Address - Phone:141-358-6770
Mailing Address - Fax:
Practice Address - Street 1:48 NORTH FARMS ROAD
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039
Practice Address - Country:US
Practice Address - Phone:141-358-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2513224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant