Healthcare Provider Details

I. General information

NPI: 1245736792
Provider Name (Legal Business Name): KRISTINA STAIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROOKLAWN DR
POMPTON PLAINS NJ
07444-1221
US

IV. Provider business mailing address

2 BROOKLAWN DR
POMPTON PLAINS NJ
07444-1221
US

V. Phone/Fax

Practice location:
  • Phone: 973-897-9629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00605200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0005355
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: