Provider Demographics
NPI:1164662003
Name:GILMORE, CHRISTINA LEE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LEE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:908-301-5582
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00487700225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics