Provider Demographics
NPI:1063626208
Name:KING, KRISTIN M (OTR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:KING
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 1:21938 ROYAL MONTREAL DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5142
Mailing Address - Country:US
Mailing Address - Phone:281-944-0001
Mailing Address - Fax:281-944-0002
Practice Address - Street 1:21938 ROYAL MONTREAL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5142
Practice Address - Country:US
Practice Address - Phone:281-944-0001
Practice Address - Fax:281-944-0002
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104239225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1658OtherBCBS
TX8T1658OtherBCBS