Provider Demographics
NPI:1083367031
Name:MEYER, CHRISTINA (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3473
Mailing Address - Country:US
Mailing Address - Phone:636-359-7900
Mailing Address - Fax:
Practice Address - Street 1:600 BREEZE PARK DR
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9139
Practice Address - Country:US
Practice Address - Phone:636-939-5223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014027154224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant