Provider Demographics
NPI:1184336737
Name:MOSES, KRISTYNA EMILY (COTA)
Entity type:Individual
Prefix:
First Name:KRISTYNA
Middle Name:EMILY
Last Name:MOSES
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KRISTYNA
Other - Middle Name:EMILY
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8122 LEGACY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1199
Mailing Address - Country:US
Mailing Address - Phone:713-870-6104
Mailing Address - Fax:
Practice Address - Street 1:6767 LAKE WOODLANDS DR # F
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2566
Practice Address - Country:US
Practice Address - Phone:281-364-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217213224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant