Provider Demographics
NPI:1841433141
Name:HOLBERG, CHRISTA MARIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:HOLBERG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E MARKET ST APT A
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1605
Mailing Address - Country:US
Mailing Address - Phone:203-988-0562
Mailing Address - Fax:
Practice Address - Street 1:45 E MARKET ST APT A
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1605
Practice Address - Country:US
Practice Address - Phone:203-988-0562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018369225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics