MEDICARE: KRYSTEN SKYLAR ESTRADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1649149352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTEN SKYLAR ESTRADA

Provider Business Mailing Address
First Line	:	12636 SUN HAVEN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4438
Country	:	US
Telephone Number	:	915-731-3603
Fax Number	:

Provider Business Practice Location Address
First Line	:	12636 SUN HAVEN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-4438
Country	:	US
Telephone Number	:	915-731-3603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2025
Last Update Date	:	10/31/2025

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