Provider Demographics
NPI:1407574577
Name:FITZPATRICK, CHRISTINA (COTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-3121
Mailing Address - Country:US
Mailing Address - Phone:708-368-4480
Mailing Address - Fax:
Practice Address - Street 1:1601 BUTTERFIELD TRL
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2959
Practice Address - Country:US
Practice Address - Phone:815-936-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.004589224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant