Provider Demographics
NPI:1609029016
Name:MCDERMOTT, KRISTIN ZIZUS (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ZIZUS
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ZIZUS
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:404 BELLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8213
Mailing Address - Country:US
Mailing Address - Phone:717-741-3410
Mailing Address - Fax:
Practice Address - Street 1:404 BELLAIRE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8213
Practice Address - Country:US
Practice Address - Phone:717-741-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0C0054870225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist