Provider Demographics
NPI:1881858785
Name:SHILLINGSFORD, KRISTIN NISSLEY (OT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NISSLEY
Last Name:SHILLINGSFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 THORLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-3133
Mailing Address - Country:US
Mailing Address - Phone:717-774-5906
Mailing Address - Fax:
Practice Address - Street 1:65 BILLERBECK ST
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9375
Practice Address - Country:US
Practice Address - Phone:717-718-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003036L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019317170003Medicaid