Provider Demographics
NPI:1821490319
Name:OTTAVIANO, KRISTIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:OTTAVIANO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:OTTAVIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:915 DANFORTH ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-1645
Mailing Address - Country:US
Mailing Address - Phone:518-542-6705
Mailing Address - Fax:
Practice Address - Street 1:915 DANFORTH STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-1645
Practice Address - Country:US
Practice Address - Phone:518-542-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist