Provider Demographics
NPI:1013745421
Name:RICHARDSON, KRISTIN RENEE (OTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:TEAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:75860-2505
Mailing Address - Country:US
Mailing Address - Phone:903-390-8282
Mailing Address - Fax:
Practice Address - Street 1:425 WEBB AVE
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860-2505
Practice Address - Country:US
Practice Address - Phone:903-390-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210349224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant