Provider Demographics
NPI:1568665545
Name:CARTER, KRISTAN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:CARTER
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 1:6215 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4843
Mailing Address - Country:US
Mailing Address - Phone:440-801-1284
Mailing Address - Fax:
Practice Address - Street 1:150 ERIE CT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1724
Practice Address - Country:US
Practice Address - Phone:440-984-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 005414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340789758OtherCHILDREN'S DEV CTR. TAXID
OH7255198Medicaid
OH7255198Medicaid