Provider Demographics
NPI:1639651334
Name:MOONEYHAM, CHRISTINA ALEJANDRA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALEJANDRA
Last Name:MOONEYHAM
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ALEJANDRA
Other - Last Name:YBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 LAKE RD STE 700B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4988
Mailing Address - Country:US
Mailing Address - Phone:979-480-0018
Mailing Address - Fax:979-314-7368
Practice Address - Street 1:210 LAKE RD STE 700B
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4988
Practice Address - Country:US
Practice Address - Phone:979-480-0018
Practice Address - Fax:979-314-7368
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119393225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics