Provider Demographics
NPI:1083153993
Name:MASTERSON, CHRISTINA ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSE
Last Name:MASTERSON
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 1:306 N BARKER RD
Mailing Address - Street 2:#252
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9818
Mailing Address - Country:US
Mailing Address - Phone:509-869-9107
Mailing Address - Fax:
Practice Address - Street 1:405 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:ID
Practice Address - Zip Code:83867
Practice Address - Country:US
Practice Address - Phone:208-556-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist