Provider Demographics
NPI:1740373372
Name:ANTHONY, KRISTINA (OTRL)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WASHINGTON PLACE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6706
Mailing Address - Country:US
Mailing Address - Phone:603-644-5900
Mailing Address - Fax:603-644-5902
Practice Address - Street 1:20 WASHINGTON PLACE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6706
Practice Address - Country:US
Practice Address - Phone:603-644-5900
Practice Address - Fax:603-644-5902
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1558225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30414079Medicaid
NH13Y004680NH02OtherBLUE CROSS BLUE SHIELD
NHAA51080OtherHARVARD PILGRIM
NH8281456OtherCIGNA
NH30414079Medicaid