Provider Demographics
NPI:1689066912
Name:OOSTERBAAN, CHRISTIAN
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:OOSTERBAAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3420
Mailing Address - Country:US
Mailing Address - Phone:559-917-0574
Mailing Address - Fax:
Practice Address - Street 1:4317 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3420
Practice Address - Country:US
Practice Address - Phone:559-917-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3066224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant