Provider Demographics
NPI:1619036506
Name:DOUGLASS, KRISTEN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:DOUGLASS
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 1:144 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2886
Mailing Address - Country:US
Mailing Address - Phone:603-459-2795
Mailing Address - Fax:603-459-2783
Practice Address - Street 1:144 CANAL ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2886
Practice Address - Country:US
Practice Address - Phone:603-882-6333
Practice Address - Fax:603-459-2795
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1187225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH272746OtherCIGNA
NH561822OtherAETNA
NH99560056Medicaid
NH626514OtherHARVARD PILGRIM
13Y002968NH01OtherANTHEM BCBS
NH020377315OtherCOMM TAX ID
NH761242OtherTUFTS