Provider Demographics
NPI:1679892723
Name:ALLEN, KRISTEN GAYLE (OT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GAYLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CODY DR
Mailing Address - Street 2:#33
Mailing Address - City:THURMONT
Mailing Address - State:MD
Mailing Address - Zip Code:21788-1687
Mailing Address - Country:US
Mailing Address - Phone:240-344-5005
Mailing Address - Fax:
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:#110
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-296-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3150225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist