Provider Demographics
NPI:1679638233
Name:HOLDOM, KRISTIN LEIGH (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:HOLDOM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1446
Mailing Address - Country:US
Mailing Address - Phone:508-404-7087
Mailing Address - Fax:
Practice Address - Street 1:CRITERION CHILD
Practice Address - Street 2:567 PEARL ST.
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440
Practice Address - Country:US
Practice Address - Phone:978-632-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MA10218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist