Provider Demographics
NPI:1033446117
Name:MCLEOD, KRISTI KAROL (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:KAROL
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 COUNTY ROAD 1080
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-5306
Mailing Address - Country:US
Mailing Address - Phone:903-389-6193
Mailing Address - Fax:
Practice Address - Street 1:3300 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2412
Practice Address - Country:US
Practice Address - Phone:903-641-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208888224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant