Provider Demographics
NPI:1336244375
Name:CONNELL, KRISTIN LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LYNN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:LYNN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1891 STATION PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304
Mailing Address - Country:US
Mailing Address - Phone:763-755-4275
Mailing Address - Fax:763-755-4261
Practice Address - Street 1:1891 STATION PARKWAY
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304
Practice Address - Country:US
Practice Address - Phone:763-755-4275
Practice Address - Fax:763-755-4261
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103281225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist