Provider Demographics
NPI:1013498526
Name:KRYSTYNIAK-COLLINS, JOAN (OTR)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KRYSTYNIAK-COLLINS
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 1:11517 COUNTY ROAD 917
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:TX
Mailing Address - Zip Code:76035-4505
Mailing Address - Country:US
Mailing Address - Phone:817-578-7479
Mailing Address - Fax:
Practice Address - Street 1:1019 HOLDEN ST
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4937
Practice Address - Country:US
Practice Address - Phone:817-578-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100823225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100823OtherOT LICENSE