Provider Demographics
NPI:1114588100
Name:MAGNUSON, CHRISTINA (OTR)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-2000
Mailing Address - Country:US
Mailing Address - Phone:505-832-4471
Mailing Address - Fax:505-832-4472
Practice Address - Street 1:2422 E. HIGHWAY 333
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035
Practice Address - Country:US
Practice Address - Phone:505-832-4471
Practice Address - Fax:505-832-4472
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT-2023-0133225XP0200X
TX102743225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist