Healthcare Provider Details

I. General information

NPI: 1477882850
Provider Name (Legal Business Name): KRISTEN LYNN PRAYTO MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 BONELLI CT
MELBOURNE FL
32934-9088
US

IV. Provider business mailing address

1564 BONELLI CT
MELBOURNE FL
32934-9088
US

V. Phone/Fax

Practice location:
  • Phone: 518-755-1562
  • Fax: 877-280-2049
Mailing address:
  • Phone: 518-755-1562
  • Fax: 877-280-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number011346-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: