Provider Demographics
NPI:1851766406
Name:CHRISTIE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOT
Mailing Address - Street 1:35 BROADWAY
Mailing Address - Street 2:2B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4100
Mailing Address - Country:US
Mailing Address - Phone:206-696-2103
Mailing Address - Fax:
Practice Address - Street 1:11567 CANTERWOOD BLVD NW
Practice Address - Street 2:ST ANTHONY HOSPITAL SUITE 20
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332
Practice Address - Country:US
Practice Address - Phone:253-530-2682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60095214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist