Provider Demographics
NPI:1659724797
Name:DUPONT, CHRISHNA (COTA)
Entity Type:Individual
Prefix:
First Name:CHRISHNA
Middle Name:
Last Name:DUPONT
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 1:17122 KIRKLAND OAKS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5537
Mailing Address - Country:US
Mailing Address - Phone:678-787-7887
Mailing Address - Fax:
Practice Address - Street 1:17122 KIRKLAND OAKS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5537
Practice Address - Country:US
Practice Address - Phone:678-787-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211262225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics