Provider Demographics
NPI:1619438223
Name:STANLEY, KRISTEN LYNN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457
Mailing Address - Country:US
Mailing Address - Phone:207-794-7228
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-794-7228
Practice Address - Fax:207-794-4001
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist