Provider Demographics
NPI:1639505530
Name:MORTON, KRISTEN (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MORTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1725
Mailing Address - Country:US
Mailing Address - Phone:570-463-5297
Mailing Address - Fax:
Practice Address - Street 1:300 FRIBERG PKWY
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3900
Practice Address - Country:US
Practice Address - Phone:508-329-6158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012828225X00000X
MA10912225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist