Provider Demographics
NPI:1851570501
Name:THOMAS, CHRISTINE SUE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:SUE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 W STATE ROAD 14
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-7915
Mailing Address - Country:US
Mailing Address - Phone:574-223-5027
Mailing Address - Fax:
Practice Address - Street 1:827 W 13TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-2502
Practice Address - Country:US
Practice Address - Phone:574-223-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001023A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist