Provider Demographics
NPI:1255710190
Name:WATERMAN, KRISTINA ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANNE
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ERMER RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1273
Mailing Address - Country:US
Mailing Address - Phone:603-893-0984
Mailing Address - Fax:
Practice Address - Street 1:15 ERMER RD UNIT 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1273
Practice Address - Country:US
Practice Address - Phone:603-893-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist