Provider Demographics
NPI:1912795667
Name:CRISPIN-DUARTE, GISELLE
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:CRISPIN-DUARTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1705
Mailing Address - Country:US
Mailing Address - Phone:254-349-4990
Mailing Address - Fax:254-349-4990
Practice Address - Street 1:9101 PANTHERWAY
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-8614
Practice Address - Country:US
Practice Address - Phone:254-537-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218645224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant