Provider Demographics
NPI:1265563316
Name:LANE, CHRISTINA JEAN (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JEAN
Last Name:LANE
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 1:15325 REDMOND WAY
Mailing Address - Street 2:APT G232
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6844
Mailing Address - Country:US
Mailing Address - Phone:425-894-4451
Mailing Address - Fax:
Practice Address - Street 1:925 SENECA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2742
Practice Address - Country:US
Practice Address - Phone:206-625-7373
Practice Address - Fax:206-515-5886
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8486235Medicaid
WA5384LAOtherBLUE SHIELD #
WA8486235Medicaid