Provider Demographics
NPI:1720540891
Name:MADSEN, CHRISTINE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:MADSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DARLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12067 RUE DES AMIS
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2356
Mailing Address - Country:US
Mailing Address - Phone:858-336-9019
Mailing Address - Fax:
Practice Address - Street 1:12067 RUE DES AMIS
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2356
Practice Address - Country:US
Practice Address - Phone:858-336-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist