Healthcare Provider Details

I. General information

NPI: 1215002886
Provider Name (Legal Business Name): KRISTEN ALLEN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COMMONWEALTH AVE 124 CONTE FORUM, BOSTON COLLEGE
CHESTNUT HILL MA
02467-3800
US

IV. Provider business mailing address

11 ANSELM TER
BRIGHTON MA
02135-3106
US

V. Phone/Fax

Practice location:
  • Phone: 617-552-1045
  • Fax: 617-552-2392
Mailing address:
  • Phone: 617-552-1045
  • Fax: 617-552-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: