Provider Demographics
NPI:1730499815
Name:HERGENHAN, KRISTEN MARGARET
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARGARET
Last Name:HERGENHAN
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 1:90 HOUTMAN DR
Mailing Address - Street 2:
Mailing Address - City:WALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:12586-2222
Mailing Address - Country:US
Mailing Address - Phone:845-541-7863
Mailing Address - Fax:
Practice Address - Street 1:90 HOUTMAN DR
Practice Address - Street 2:
Practice Address - City:WALDEN
Practice Address - State:NY
Practice Address - Zip Code:12586-2222
Practice Address - Country:US
Practice Address - Phone:845-541-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011038-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist