Provider Demographics
NPI:1457560203
Name:VUE, CHRISTINE KONHZOUA (OTR)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:KONHZOUA
Last Name:VUE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:KONHZOUA
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:3912 10TH ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-4700
Practice Address - Fax:253-848-2284
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1400610225X00000X
WAOT60002446225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0291626OtherDEPT. OF LABOR AND INDUSTRIES
WA8512717Medicaid