Provider Demographics
NPI:1992000947
Name:HAMRE, KRYSTAL DAWN (MS, OTR)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DAWN
Last Name:HAMRE
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 TIMBERGLEN DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1917
Mailing Address - Country:US
Mailing Address - Phone:972-355-3895
Mailing Address - Fax:
Practice Address - Street 1:1301 JUSTIN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2124
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109716225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics