Provider Demographics
NPI:1730462995
Name:ELLINGSEN, KRISTIN ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANN
Last Name:ELLINGSEN
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 1:9 GLENN LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3011
Mailing Address - Country:US
Mailing Address - Phone:845-270-2925
Mailing Address - Fax:
Practice Address - Street 1:9 GLENN LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3011
Practice Address - Country:US
Practice Address - Phone:845-270-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015761-1225XP0200X
NJ46TR00508000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics