Provider Demographics
NPI:1720279078
Name:CAMACHO, KRISTIN MARIETTA (MA OTR/L, MED)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIETTA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA OTR/L, MED
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARIETTA
Other - Last Name:VAN GIEZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OTR/L, MED
Mailing Address - Street 1:12 KENDALL CT
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-2502
Mailing Address - Country:US
Mailing Address - Phone:973-813-7265
Mailing Address - Fax:973-813-7295
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5419
Practice Address - Country:US
Practice Address - Phone:800-530-3247
Practice Address - Fax:973-740-9007
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00280200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist