Provider Demographics
NPI:1316726573
Name:YOUNG, KRISTIN MICHELLE (OT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2605 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4842
Mailing Address - Country:US
Mailing Address - Phone:817-688-5492
Mailing Address - Fax:
Practice Address - Street 1:7241 CROWLEY RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-3504
Practice Address - Country:US
Practice Address - Phone:817-600-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist