Provider Demographics
NPI:1740736529
Name:GRASSER, KRISTA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:GRASSER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 SOUTH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-6183
Mailing Address - Country:US
Mailing Address - Phone:409-498-4066
Mailing Address - Fax:254-848-4193
Practice Address - Street 1:500 SOUTH ST STE 300
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-6183
Practice Address - Country:US
Practice Address - Phone:409-498-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117763225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist