Provider Demographics
NPI:1578052536
Name:GREY, KRISTA (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GREY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:MOFFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:920 WOLF HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2301
Mailing Address - Country:US
Mailing Address - Phone:203-910-1858
Mailing Address - Fax:
Practice Address - Street 1:3396 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3812
Practice Address - Country:US
Practice Address - Phone:203-756-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002195225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist