Provider Demographics
NPI:1649806068
Name:WEIR, KRISTINE MARIE (OTR)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:WEIR
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 1:916 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7845
Mailing Address - Country:US
Mailing Address - Phone:469-580-5778
Mailing Address - Fax:
Practice Address - Street 1:916 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7845
Practice Address - Country:US
Practice Address - Phone:469-580-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213505224Z00000X
TX121439225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant