Provider Demographics
NPI:1174856462
Name:CHRISTIANSEN, KATIE MARIE (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 MAYFIELD AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5713
Mailing Address - Country:US
Mailing Address - Phone:520-349-0363
Mailing Address - Fax:
Practice Address - Street 1:3638 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5702
Practice Address - Country:US
Practice Address - Phone:310-204-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist