Provider Demographics
NPI:1538718226
Name:GLIDDEN, KRISTEN FAVRE (OTR, MOT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:FAVRE
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:OTR, MOT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:FAVRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4770 STATE HIGHWAY 121 STE 130
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-2913
Practice Address - Country:US
Practice Address - Phone:469-830-9030
Practice Address - Fax:469-390-0010
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120245225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist