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General NPI Number Information
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NPI Number | 1831657949
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Entity Type | Individual
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Provider Name | MAIGEN DICRISTOFARO OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1850 E LEAGUE CITY PKWY
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City | LEAGUE CITY
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State | TX
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Zip | 77573-2507
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Country | US
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Telephone | 346-646-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 982A RANDOLPH ST
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City | HOUSTON
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State | TX
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Zip | 77088-6150
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Country | US
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Telephone | 219-229-2632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 125298
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License Number State | TX
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