Provider Demographics
NPI:1760698054
Name:SHACKELFORD, KRISTEN ELIZABETH (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:598 SEARSMONT RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04862
Mailing Address - Country:US
Mailing Address - Phone:207-785-2576
Mailing Address - Fax:
Practice Address - Street 1:598 SEARSMONT RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:ME
Practice Address - Zip Code:04862-6405
Practice Address - Country:US
Practice Address - Phone:207-785-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1745225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist