=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225491996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN LAW OTR/L, CLT, WCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2016
-----------------------------------------------------
Last Update Date | 01/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 EASTON RD SUITE 1 SOUTH
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-659-1137
-----------------------------------------------------
Fax | 215-659-1147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 EASTON RD STE 1
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-659-1137
-----------------------------------------------------
Fax | 215-659-1147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OC009781
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------