Basic Information
| Provider Information | |||||||||
| NPI: | 1518449438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINGSBURY | ||||||||
| FirstName: | KATLYN | ||||||||
| MiddleName: | MAXWELL | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 AMHERST ST STE 22 | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038800448 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 GRANITE ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031024000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036260760 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 10/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 024033 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OT3530 | ME | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 2804 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2804 | 01 | NH | ALLIED HEALTH | OTHER |