Provider Demographics
NPI:1013776012
Name:SHIN, CHRISTINA (OTD, OTR/L, CLT-LANA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SHIN
Suffix:
Gender:F
Credentials:OTD, OTR/L, CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12786 NEWHOPE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5537
Mailing Address - Country:US
Mailing Address - Phone:714-235-0359
Mailing Address - Fax:
Practice Address - Street 1:12786 NEWHOPE ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5537
Practice Address - Country:US
Practice Address - Phone:949-866-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist