Provider Demographics
NPI:1164673877
Name:DICKENS, CHRISTINE (OT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16171 N BRINSON ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5509
Mailing Address - Country:US
Mailing Address - Phone:208-442-2525
Mailing Address - Fax:208-442-2505
Practice Address - Street 1:16171 N BRINSON ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5509
Practice Address - Country:US
Practice Address - Phone:208-442-2525
Practice Address - Fax:208-442-2505
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist