Provider Demographics
NPI:1861815649
Name:CONCEPCION, KRYSTLE LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:LEE
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:LEE
Other - Last Name:CHISHOLM (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 NEEDHAMS LANDING ROAD APT. 401
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905
Mailing Address - Country:US
Mailing Address - Phone:781-439-3103
Mailing Address - Fax:
Practice Address - Street 1:9 NEEDHAMS LANDING ROAD APT. 401
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905
Practice Address - Country:US
Practice Address - Phone:781-439-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12403225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist