Provider Demographics
NPI:1356797161
Name:LOFTUS, KRISTINA MERCEDES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MERCEDES
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:MERCEDES
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:507 AIRPORT EXECUTIVE PARK
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5238
Mailing Address - Country:US
Mailing Address - Phone:845-262-5313
Mailing Address - Fax:
Practice Address - Street 1:327 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3420
Practice Address - Country:US
Practice Address - Phone:845-356-2900
Practice Address - Fax:845-356-7797
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020466225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400147034Medicare PIN