Provider Demographics
NPI:1356716765
Name:CHRISTIANSON, CARLEE (COTA)
Entity type:Individual
Prefix:MS
First Name:CARLEE
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:COTA
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 436
Mailing Address - Street 2:1320 4TH
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1104
Mailing Address - Country:US
Mailing Address - Phone:641-357-5056
Mailing Address - Fax:
Practice Address - Street 1:509 BUDDY HOLLY PLACE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1359
Practice Address - Country:US
Practice Address - Phone:641-357-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080411224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant