Provider Demographics
NPI:1164069308
Name:ADAMS, KRISTEN MICHELLE (OTR)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 GULFSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5981
Mailing Address - Country:US
Mailing Address - Phone:469-343-2876
Mailing Address - Fax:214-975-2928
Practice Address - Street 1:7002 LEBANON RD STE 102
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7460
Practice Address - Country:US
Practice Address - Phone:469-343-2876
Practice Address - Fax:214-975-2928
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115152225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty