Provider Demographics
NPI:1952891095
Name:BERRIGAN, KRISTA (OT)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BERRIGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:BUSCHBACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:803 HACIENDA LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-5109
Mailing Address - Country:US
Mailing Address - Phone:505-632-1823
Mailing Address - Fax:
Practice Address - Street 1:803 HACIENDA LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5109
Practice Address - Country:US
Practice Address - Phone:505-632-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00718300225X00000X
NM4329225XP0019X
NY020060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation