Provider Demographics
NPI:1134255623
Name:OLIVER, KRISTIN EILEEN (OTR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:EILEEN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-4604
Mailing Address - Country:US
Mailing Address - Phone:631-793-3327
Mailing Address - Fax:
Practice Address - Street 1:585 DONNA DR
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-4604
Practice Address - Country:US
Practice Address - Phone:631-793-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist