Healthcare Provider Details

I. General information

NPI: 1154886356
Provider Name (Legal Business Name): KRISTIN DOLORES VALADEZ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 SLIDE RD SUITE 204
LUBBOCK TX
79424-5707
US

IV. Provider business mailing address

6105 7TH ST
LUBBOCK TX
79416
US

V. Phone/Fax

Practice location:
  • Phone: 806-686-0429
  • Fax:
Mailing address:
  • Phone: 956-225-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number119656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: