Provider Demographics
NPI:1407579147
Name:MCCHRISTEN, FAITH
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:MCCHRISTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 CLUB CT
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1547
Mailing Address - Country:US
Mailing Address - Phone:708-969-4202
Mailing Address - Fax:
Practice Address - Street 1:10300 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3541
Practice Address - Country:US
Practice Address - Phone:708-361-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056010844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty