Provider Demographics
NPI:1801401336
Name:LATINO, KRISTIN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:LATINO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:LUPISELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:20 EMILE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3169
Mailing Address - Country:US
Mailing Address - Phone:774-239-5433
Mailing Address - Fax:
Practice Address - Street 1:130 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5130
Practice Address - Country:US
Practice Address - Phone:800-865-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist