Provider Demographics
NPI:1073714648
Name:FORTUNATO, CHRISTIAN HOPE (BS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:HOPE
Last Name:FORTUNATO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:BARRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:11 LEATHER OAK TRL
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3655
Mailing Address - Country:US
Mailing Address - Phone:661-496-6290
Mailing Address - Fax:
Practice Address - Street 1:11 LEATHER OAK TRL
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-3655
Practice Address - Country:US
Practice Address - Phone:661-496-6290
Practice Address - Fax:661-496-6290
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3853225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics