Provider Demographics
NPI:1407249600
Name:STEVENS, CHRISTEN FECHTEL (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTEN
Middle Name:FECHTEL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:CHRISTEN
Other - Middle Name:GRACE
Other - Last Name:FECHTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:14286 BEACH BLVD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1561
Mailing Address - Country:US
Mailing Address - Phone:904-345-7510
Mailing Address - Fax:
Practice Address - Street 1:14286 BEACH BLVD
Practice Address - Street 2:SUITE 34
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-1561
Practice Address - Country:US
Practice Address - Phone:904-345-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist