Provider Demographics
NPI:1992005482
Name:CZEKALSKI, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CZEKALSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CZEKALSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:520 E 81ST ST
Mailing Address - Street 2:APT 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7095
Mailing Address - Country:US
Mailing Address - Phone:917-374-9128
Mailing Address - Fax:
Practice Address - Street 1:520 E 81ST ST
Practice Address - Street 2:APT 6A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7095
Practice Address - Country:US
Practice Address - Phone:917-374-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist