Provider Demographics
NPI:1972991818
Name:BEAUDOIN, CHRISTINA ELIZABETH (OTR)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:BEAUDOIN
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 1:1900 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1806
Mailing Address - Country:US
Mailing Address - Phone:503-538-2108
Mailing Address - Fax:503-538-1768
Practice Address - Street 1:25117 SW PARKWAY AVE
Practice Address - Street 2:STE D
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR336166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist