Provider Demographics
NPI:1689965246
Name:CARDWELL, CRISTEN LEE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CRISTEN
Middle Name:LEE
Last Name:CARDWELL
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 1:8310 AUTUMN WAY
Mailing Address - Street 2:APT 3-D
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-2913
Mailing Address - Country:US
Mailing Address - Phone:301-725-4221
Mailing Address - Fax:
Practice Address - Street 1:8310 AUTUMN WAY
Practice Address - Street 2:APT 3-D
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-2913
Practice Address - Country:US
Practice Address - Phone:301-725-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist