Provider Demographics
NPI:1659646461
Name:JONES, CHRISTINE WALLER (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:WALLER
Last Name:JONES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CHURCHILL LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2156
Mailing Address - Country:US
Mailing Address - Phone:770-642-9210
Mailing Address - Fax:
Practice Address - Street 1:1475 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2139
Practice Address - Country:US
Practice Address - Phone:678-591-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000156225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist