Provider Demographics
NPI:1972135382
Name:CHUPRYNA, KRISTY A (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:A
Last Name:CHUPRYNA
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 1:1234 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1404
Mailing Address - Country:US
Mailing Address - Phone:949-436-0176
Mailing Address - Fax:
Practice Address - Street 1:3900 BIRCH ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2226
Practice Address - Country:US
Practice Address - Phone:949-955-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8979225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics