Provider Demographics
NPI:1477129724
Name:WEDEMEIER, CHRISTINA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:WEDEMEIER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 E DEVON RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8395
Mailing Address - Country:US
Mailing Address - Phone:386-341-4055
Mailing Address - Fax:
Practice Address - Street 1:883 E DEVON RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8395
Practice Address - Country:US
Practice Address - Phone:386-341-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ046884224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty