Provider Demographics
NPI:1598257990
Name:COULTHARD-CHILDERS, CHRISTINA WINNIE
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:WINNIE
Last Name:COULTHARD-CHILDERS
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 1:230 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-2247
Mailing Address - Country:US
Mailing Address - Phone:402-340-0271
Mailing Address - Fax:
Practice Address - Street 1:230 E 7TH ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-2247
Practice Address - Country:US
Practice Address - Phone:402-340-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE951364OtherNEBRASKA DEPARTMENT OF EDUCATION-SERVICE AGENCY ID
NE434OtherNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES-LICENSURE UNIT