Provider Demographics
NPI:1861957409
Name:MARTINO, KRISTIE LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEE
Last Name:MARTINO
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 1:27 FARMER DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1702
Mailing Address - Country:US
Mailing Address - Phone:609-661-0906
Mailing Address - Fax:
Practice Address - Street 1:56 MAIN ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-8896
Practice Address - Country:US
Practice Address - Phone:609-388-4782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00778500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty