Provider Demographics
NPI:1336039296
Name:O'CONNOR, KRISTA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:O'CONNOR
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 1:1235 WATERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5772
Mailing Address - Country:US
Mailing Address - Phone:914-382-4794
Mailing Address - Fax:
Practice Address - Street 1:1235 WATERSTONE LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5772
Practice Address - Country:US
Practice Address - Phone:914-382-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7184225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation