Provider Demographics
NPI:1043453285
Name:VANDEZANDE, CHRISTINA A (OT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:A
Last Name:VANDEZANDE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:ERBISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2822 VENTURE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-8855
Mailing Address - Country:US
Mailing Address - Phone:906-228-1863
Mailing Address - Fax:906-225-0460
Practice Address - Street 1:2822 VENTURE DRIVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-8855
Practice Address - Country:US
Practice Address - Phone:906-228-1863
Practice Address - Fax:906-225-0460
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5201001027OtherLICENSE FOR OCCUPATIONAL THERAPY
P1657003Medicare UPIN