Provider Demographics
NPI:1942767181
Name:MAYSON, KRISTYN TERNBERG (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:TERNBERG
Last Name:MAYSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 BLACK PINE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6913
Mailing Address - Country:US
Mailing Address - Phone:864-884-6866
Mailing Address - Fax:
Practice Address - Street 1:147 VERA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3756
Practice Address - Country:US
Practice Address - Phone:803-629-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-03-01
Deactivation Date:2019-02-25
Deactivation Code:
Reactivation Date:2019-03-01
Provider Licenses
StateLicense IDTaxonomies
SCOT5486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist