Provider Demographics
NPI:1245225739
Name:SMITH, CHRISTOPHER (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 E CUERVO LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-4647
Mailing Address - Country:US
Mailing Address - Phone:928-246-5440
Mailing Address - Fax:928-726-0092
Practice Address - Street 1:11274 S FORTUNA RD
Practice Address - Street 2:SUITE I-3
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7849
Practice Address - Country:US
Practice Address - Phone:928-726-0091
Practice Address - Fax:928-726-0092
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1888225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ77119Medicare ID - Type UnspecifiedGROUP PROVIDER IDENTIFI