Provider Demographics
NPI:1457697765
Name:CHRISTENSEN, THOMAS ERIC (COTA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ERIC
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SABAEL
Mailing Address - State:NY
Mailing Address - Zip Code:12864-1603
Mailing Address - Country:US
Mailing Address - Phone:518-648-5409
Mailing Address - Fax:
Practice Address - Street 1:64 DANBURY RD
Practice Address - Street 2:ONWARD HEALTH CARE
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:866-696-8773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008095-1224Z00000X
PAOP007266224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant