Provider Demographics
NPI:1134369150
Name:BOVA, KRISTIN ALLISON (MS/OTR/L)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ALLISON
Last Name:BOVA
Suffix:
Gender:F
Credentials:MS/OTR/L
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:BOVA
Other - Last Name:BAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS/OTR/L
Mailing Address - Street 1:250 E 65TH ST
Mailing Address - Street 2:APT 13 C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6616
Mailing Address - Country:US
Mailing Address - Phone:917-406-1752
Mailing Address - Fax:
Practice Address - Street 1:250 E 65TH ST
Practice Address - Street 2:APT 13 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6616
Practice Address - Country:US
Practice Address - Phone:917-406-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010230-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist