Provider Demographics
NPI:1689657561
Name:CHRISTENSON, CAROLYN ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ANN
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 16TH ST
Mailing Address - Street 2:STE 212
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5585
Mailing Address - Country:US
Mailing Address - Phone:707-822-7525
Mailing Address - Fax:707-822-7539
Practice Address - Street 1:1125 16TH ST
Practice Address - Street 2:STE 212
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5585
Practice Address - Country:US
Practice Address - Phone:707-822-7525
Practice Address - Fax:707-822-7539
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ270672Medicare ID - Type Unspecified