Provider Demographics
NPI:1871508580
Name:INMAN, KRISTEN CUSHMAN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CUSHMAN
Last Name:INMAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4714
Mailing Address - Country:US
Mailing Address - Phone:207-892-8935
Mailing Address - Fax:207-892-8935
Practice Address - Street 1:58 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4714
Practice Address - Country:US
Practice Address - Phone:207-892-8935
Practice Address - Fax:207-892-8935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1037225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME237-4358OtherAETNA PROVIDER NUMBER
ME061495OtherANTHEM PROVIDER NUMBER