Provider Demographics
NPI:1225510290
Name:APODACA, CHRISTINE KIMBERLY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KIMBERLY
Last Name:APODACA
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 1:3028 KNIK AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1204
Mailing Address - Country:US
Mailing Address - Phone:907-455-4899
Mailing Address - Fax:
Practice Address - Street 1:3501 DENALI ST STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4039
Practice Address - Country:US
Practice Address - Phone:907-455-4899
Practice Address - Fax:907-268-5148
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK136510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty