=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275258709
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTA LYNNE METZINGER OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2022
-----------------------------------------------------
Last Update Date | 10/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MEDICAL CENTER PKWY STE 100
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77340-4959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-293-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 WINCHESTER RD
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77340-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-692-6930
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 106065
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------