Provider Demographics
NPI:1457012197
Name:TEGEL, KRISTEN (COTA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TEGEL
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 1:59 S FLAGSTONE PATH CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6624
Mailing Address - Country:US
Mailing Address - Phone:281-705-2673
Mailing Address - Fax:
Practice Address - Street 1:59 S FLAGSTONE PATH CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-6624
Practice Address - Country:US
Practice Address - Phone:281-705-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217037224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant