Provider Demographics
NPI:1366945131
Name:GREGORY, KRISTIN ANN (OTR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PROSPECT PARK SW APT E6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5998
Mailing Address - Country:US
Mailing Address - Phone:718-877-1420
Mailing Address - Fax:
Practice Address - Street 1:540 PRESIDENT ST STE 1E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1491
Practice Address - Country:US
Practice Address - Phone:718-858-0088
Practice Address - Fax:718-858-1188
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-223131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0-223131OtherOT LICENSE