Provider Demographics
NPI:1487837381
Name:CHRISTENSEN, LAURIE KAYE (COTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:KAYE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 W 9600 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9214
Mailing Address - Country:US
Mailing Address - Phone:801-766-2071
Mailing Address - Fax:
Practice Address - Street 1:6944 W 9600 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-9214
Practice Address - Country:US
Practice Address - Phone:801-766-2071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352596-4202251E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health