Provider Demographics
NPI:1841517950
Name:COUTU, KRISTEN L (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:COUTU
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 SPIRIT WIND FARM RD.
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027
Mailing Address - Country:US
Mailing Address - Phone:207-651-3838
Mailing Address - Fax:
Practice Address - Street 1:CHILD DEVELOPMENT SERVICES YORK
Practice Address - Street 2:39 LIMERICK RD.
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046
Practice Address - Country:US
Practice Address - Phone:207-324-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2044225X00000X
ME2292225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist