Provider Demographics
NPI:1457308405
Name:JORGENSEN, CHRISTIAN D (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:D
Last Name:JORGENSEN
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 1:1497 MAIN ST # 265
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4612
Mailing Address - Country:US
Mailing Address - Phone:509-994-2737
Mailing Address - Fax:
Practice Address - Street 1:1497 MAIN ST # 265
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4612
Practice Address - Country:US
Practice Address - Phone:509-994-2737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002537225X00000X
FLOT15164225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006249OtherNBCOT
FLOT15164OtherFL STATE OT