Provider Demographics
NPI:1629518618
Name:WARN, CHRISTINA MARIE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:WARN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5740 W MARVIN LN
Mailing Address - Street 2:276
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6222
Mailing Address - Country:US
Mailing Address - Phone:406-951-0180
Mailing Address - Fax:
Practice Address - Street 1:3169 S BOWN WAY
Practice Address - Street 2:276
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5400
Practice Address - Country:US
Practice Address - Phone:208-433-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT-1728225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics