Individual
MISS KRISTINA ANNE NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
930 W CENTERVILLE RD STE C, GARLAND, TX 75041-5854
(972) 303-7021
Mailing address
4218 US HIGHWAY 80 E APT 2067, MESQUITE, TX 75149-1173
(254) 205-1171
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215045
TX
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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