Provider Demographics
NPI:1922501030
Name:POMAZANKO, CHRISTOPHER D
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:POMAZANKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 WHISKEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8749
Mailing Address - Country:US
Mailing Address - Phone:248-495-0613
Mailing Address - Fax:
Practice Address - Street 1:777 9TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8135
Practice Address - Country:US
Practice Address - Phone:239-261-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16022224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant