Provider Demographics
NPI:1780976670
Name:GARWOOD, KIRSTEN WAGNER (OTR)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:WAGNER
Last Name:GARWOOD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:KIRSTEN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:10235 SHADOW WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5047
Mailing Address - Country:US
Mailing Address - Phone:214-228-7305
Mailing Address - Fax:214-820-9369
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1520
Practice Address - Country:US
Practice Address - Phone:214-228-7305
Practice Address - Fax:214-820-9369
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101934225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation