Provider Demographics
NPI:1821212127
Name:CROSSON, KRISTIN DIANE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DIANE
Last Name:CROSSON
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 1:218 OAKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052
Mailing Address - Country:US
Mailing Address - Phone:716-652-9376
Mailing Address - Fax:
Practice Address - Street 1:21 ELM ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2501
Practice Address - Country:US
Practice Address - Phone:716-913-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000905221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist