Provider Demographics
NPI:1679960561
Name:KHAL, CHRISTINA SAMAR (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SAMAR
Last Name:KHAL
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 WRIGHTSBORO RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4887
Mailing Address - Country:US
Mailing Address - Phone:706-724-6543
Mailing Address - Fax:206-350-9023
Practice Address - Street 1:2258 WRIGHTSBORO RD
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4887
Practice Address - Country:US
Practice Address - Phone:706-724-6543
Practice Address - Fax:206-350-9023
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006175225X00000X, 225XM0800X, 225XN1300X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation