MEDICARE: KRISTEN RYAN MIRELL OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.011518	IL
2	225X00000X	Occupational Therapist	18816	CA

General Provider Information

NPI Number	:	1225484959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN RYAN MIRELL OTR/L

Provider Business Mailing Address
First Line	:	1185 7TH AVE APT D
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-2778
Country	:	US
Telephone Number	:	269-757-2176
Fax Number	:

Provider Business Practice Location Address
First Line	:	WINDSOR GARDENS CENTER OF REHABILITATION
Second Line	:	637 E ROMIE LN
City	:	SALINAS
State	:	CA
Zip	:	93901
Country	:	US
Telephone Number	:	831-424-0687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	03/04/2026

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