Provider Demographics
NPI:1255987087
Name:LAI, KRISTINA MARIE (MOT, OTR)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:LAI
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:MARIE
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 JUSTIN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2150
Mailing Address - Country:US
Mailing Address - Phone:972-317-7775
Mailing Address - Fax:
Practice Address - Street 1:1301 JUSTIN RD STE 206
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2150
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119950225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics