Provider Demographics
NPI:1861892721
Name:MULONE, KRISTEN (OT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MULONE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:M
Other - Last Name:MCGINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:6363 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2716
Practice Address - Country:US
Practice Address - Phone:716-688-5709
Practice Address - Fax:716-688-5709
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012079225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist