Provider Demographics
NPI:1295796944
Name:PUFNOCK, CHRISTINE (MS, OTR L)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:PUFNOCK
Suffix:
Gender:F
Credentials:MS, OTR L
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:MILBRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR L
Mailing Address - Street 1:3771 RAMSEY ST
Mailing Address - Street 2:STE 109-393
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7675
Mailing Address - Country:US
Mailing Address - Phone:910-551-8818
Mailing Address - Fax:910-630-6258
Practice Address - Street 1:382 BUBBLE CREEK CT
Practice Address - Street 2:UNIT 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1403
Practice Address - Country:US
Practice Address - Phone:910-551-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4683225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301907Medicaid