Provider Demographics
NPI:1740589530
Name:CHMIL, CHRISTA MACKENZIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MACKENZIE
Last Name:CHMIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1753
Mailing Address - Country:US
Mailing Address - Phone:570-561-9162
Mailing Address - Fax:
Practice Address - Street 1:915 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:PA
Practice Address - Zip Code:18421-1005
Practice Address - Country:US
Practice Address - Phone:570-785-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011796225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist