Provider Demographics
NPI:1801191291
Name:FITZGERALD, CHRISTINE M (COTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:F
Other - Last Name:WEATHERSBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-444-6350
Mailing Address - Fax:610-925-4000
Practice Address - Street 1:101 E STATE ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3109
Practice Address - Country:US
Practice Address - Phone:610-444-6350
Practice Address - Fax:610-925-4000
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001181224Z00000X
PAOP008834224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant