Provider Demographics
NPI:1780832261
Name:MAYROSE, KRISTEN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:MAYROSE
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 1:7204 SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-9604
Mailing Address - Country:US
Mailing Address - Phone:716-542-2661
Mailing Address - Fax:
Practice Address - Street 1:5677 S TRANSIT RD
Practice Address - Street 2:#318
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5842
Practice Address - Country:US
Practice Address - Phone:716-432-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004836-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics