Provider Demographics
NPI:1598764755
Name:CHRISTESEN, LYDIA LEA (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LEA
Last Name:CHRISTESEN
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6916 W ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5908
Mailing Address - Country:US
Mailing Address - Phone:198-998-0849
Mailing Address - Fax:
Practice Address - Street 1:6916 W ROBIN LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5908
Practice Address - Country:US
Practice Address - Phone:198-998-0849
Practice Address - Fax:928-777-9975
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6118225XH1200X
MI5201001462225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172068Medicaid
KYZ192731Medicare PIN
MIN85070002Medicare PIN