Provider Demographics
NPI:1730495151
Name:MCBRIDE, KRISTINE S (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:S
Last Name:MCBRIDE
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 1:1322 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5936
Mailing Address - Country:US
Mailing Address - Phone:214-418-6757
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FWY STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4566
Practice Address - Country:US
Practice Address - Phone:214-575-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110758225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110758OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUTIPATIONAL THERAPY EXAMINERS