Provider Demographics
NPI:1578853123
Name:PETTINATO, KRISTA M (OTR/L MED)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:PETTINATO
Suffix:
Gender:F
Credentials:OTR/L MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5414
Mailing Address - Country:US
Mailing Address - Phone:914-806-0223
Mailing Address - Fax:
Practice Address - Street 1:13 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5414
Practice Address - Country:US
Practice Address - Phone:914-806-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist