Provider Demographics
NPI:1922524420
Name:CHRISTIANSEN, ELYNN MICHELLE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ELYNN
Middle Name:MICHELLE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-0745
Mailing Address - Country:US
Mailing Address - Phone:435-678-3869
Mailing Address - Fax:435-678-3769
Practice Address - Street 1:364 W 100 N
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535
Practice Address - Country:US
Practice Address - Phone:435-678-3869
Practice Address - Fax:435-678-3769
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10462417-4201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist