Provider Demographics
NPI:1619342334
Name:DEVALL, KRISTIN BRITT (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:BRITT
Last Name:DEVALL
Suffix:
Gender:F
Credentials:COTA/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 LOCUST CIR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1130
Mailing Address - Country:US
Mailing Address - Phone:516-380-7868
Mailing Address - Fax:
Practice Address - Street 1:4 LOCUST CIR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-1130
Practice Address - Country:US
Practice Address - Phone:516-380-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008839-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant