Provider Demographics
NPI:1578833703
Name:CHRISTISON, TETYANA M
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:M
Last Name:CHRISTISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 COVENANT RD
Mailing Address - Street 2:APT P5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-4279
Mailing Address - Country:US
Mailing Address - Phone:803-233-1388
Mailing Address - Fax:
Practice Address - Street 1:3431 COVENANT RD
Practice Address - Street 2:APT P5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4279
Practice Address - Country:US
Practice Address - Phone:803-233-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist