Provider Demographics
NPI:1073761706
Name:COULTHURST, CHRISTINE A (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:COULTHURST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 SALT FLATS CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4910
Mailing Address - Country:US
Mailing Address - Phone:702-898-7992
Mailing Address - Fax:
Practice Address - Street 1:748 SALT FLATS CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4910
Practice Address - Country:US
Practice Address - Phone:702-898-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV09-7014225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist