Healthcare Provider Details

I. General information

NPI: 1457216178
Provider Name (Legal Business Name): KRISTELLE MARGARET BALAJADIA CEFRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18881 W DODGE RD STE 300W
ELKHORN NE
68022-4648
US

IV. Provider business mailing address

17215 MOSCATO
SAN ANTONIO TX
78247-4501
US

V. Phone/Fax

Practice location:
  • Phone: 877-230-3885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number126084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: