Provider Demographics
NPI:1083281323
Name:RICHARDSON, KYNDRA S (COTA/L)
Entity Type:Individual
Prefix:
First Name:KYNDRA
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5602
Mailing Address - Country:US
Mailing Address - Phone:702-278-2215
Mailing Address - Fax:
Practice Address - Street 1:2502 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5602
Practice Address - Country:US
Practice Address - Phone:702-278-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216571224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant