Provider Demographics
NPI:1568942639
Name:CHRISTY, ELIZABETH BLAIR (OTR)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CALINCO DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2608
Mailing Address - Country:US
Mailing Address - Phone:817-579-8758
Mailing Address - Fax:
Practice Address - Street 1:1300 E 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1496
Practice Address - Country:US
Practice Address - Phone:817-408-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109929OtherOCCUPATIONAL THERAPY LICENSE