Provider Demographics
NPI:1457313066
Name:NEELY, CHRISTOPHER MARK (OTA)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:NEELY
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:318 WEST WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324
Mailing Address - Country:US
Mailing Address - Phone:850-663-5390
Mailing Address - Fax:850-663-5391
Practice Address - Street 1:318 WEST WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324
Practice Address - Country:US
Practice Address - Phone:850-663-5390
Practice Address - Fax:850-663-5391
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9840224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant