Provider Demographics
NPI:1619673159
Name:BRITTON, KRYSTYNNA J
Entity Type:Individual
Prefix:
First Name:KRYSTYNNA
Middle Name:J
Last Name:BRITTON
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 1:20408 E BROADMOOR TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-2054
Mailing Address - Country:US
Mailing Address - Phone:314-704-3779
Mailing Address - Fax:
Practice Address - Street 1:255 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3404
Practice Address - Country:US
Practice Address - Phone:610-925-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ047066224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant