Provider Demographics
NPI:1902155005
Name:KRISTINA CARON OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:KRISTINA CARON OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/C
Authorized Official - Phone:207-939-0148
Mailing Address - Street 1:27 FLETCHER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043
Mailing Address - Country:US
Mailing Address - Phone:207-939-0148
Mailing Address - Fax:
Practice Address - Street 1:27 FLETCHER ST APT 2
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-939-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT 1451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty