Provider Demographics
NPI:1053608604
Name:KRIZAN, DESIREE LEIGH (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LEIGH
Last Name:KRIZAN
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 1:11 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:FONDA
Mailing Address - State:NY
Mailing Address - Zip Code:12068-4829
Mailing Address - Country:US
Mailing Address - Phone:518-853-4338
Mailing Address - Fax:
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015277-1225X00000X
MA9084225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist