Provider Demographics
NPI:1295796548
Name:GILL, KRISTEN JILL (MSL, MSED, ATC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JILL
Last Name:GILL
Suffix:
Gender:F
Credentials:MSL, MSED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2664
Mailing Address - Country:US
Mailing Address - Phone:201-401-7304
Mailing Address - Fax:
Practice Address - Street 1:300 TRADECENTER STE 1650
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1884
Practice Address - Country:US
Practice Address - Phone:781-935-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001214002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer