Provider Demographics
NPI:1467476820
Name:ROBERTS, CHRISTINA (COTAL LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:COTAL LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N GLEED RD
Mailing Address - Street 2:
Mailing Address - City:NACHES
Mailing Address - State:WA
Mailing Address - Zip Code:98937-9633
Mailing Address - Country:US
Mailing Address - Phone:509-577-0210
Mailing Address - Fax:
Practice Address - Street 1:111 S 3RD ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2827
Practice Address - Country:US
Practice Address - Phone:509-249-8704
Practice Address - Fax:509-249-8706
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000744224Z00000X
WAMA00013631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0135366OtherL AND I