Provider Demographics
NPI:1710170212
Name:HURLEY, CHRISTIE DENEISE (COTA/L, BA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:DENEISE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:COTA/L, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 MILL IRON RD
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24095-2940
Mailing Address - Country:US
Mailing Address - Phone:540-355-8909
Mailing Address - Fax:
Practice Address - Street 1:700 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-2430
Practice Address - Country:US
Practice Address - Phone:540-633-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1067502224Z00000X
VA0131000398224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0131000398OtherVIRGINIA BOARD OF MEDICINE