Provider Demographics
NPI:1114517067
Name:MALSBURY, CHRISTA R (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:R
Last Name:MALSBURY
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 1:1309 FLORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5919
Mailing Address - Country:US
Mailing Address - Phone:310-427-5911
Mailing Address - Fax:
Practice Address - Street 1:1309 FLORWOOD AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5919
Practice Address - Country:US
Practice Address - Phone:310-427-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA2231224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOTA2231OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY
275159OtherNBCOT