Provider Demographics
NPI:1598917429
Name:WILLSON, KRISTEN SCHILLING (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:SCHILLING
Last Name:WILLSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BUTE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12435-5014
Mailing Address - Country:US
Mailing Address - Phone:845-594-9788
Mailing Address - Fax:845-434-2941
Practice Address - Street 1:4 BUTE AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD PARK
Practice Address - State:NY
Practice Address - Zip Code:12435-5014
Practice Address - Country:US
Practice Address - Phone:845-594-9788
Practice Address - Fax:845-434-2941
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007093-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics