Provider Demographics
NPI:1013118249
Name:NELSON, KRISTEN (OT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:COLANTUONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:469 BOTANY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7196
Mailing Address - Country:US
Mailing Address - Phone:773-308-5682
Mailing Address - Fax:331-215-4711
Practice Address - Street 1:469 BOTANY BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-7196
Practice Address - Country:US
Practice Address - Phone:773-308-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2019-07-29
Deactivation Date:2009-10-01
Deactivation Code:
Reactivation Date:2016-04-22
Provider Licenses
StateLicense IDTaxonomies
FL20006225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist