Provider Demographics
NPI:1649308883
Name:LENNON, CHRISTINE ELIZABETH (OTR L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:LENNON
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 FREHOLD CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-7372
Mailing Address - Country:US
Mailing Address - Phone:919-465-4424
Mailing Address - Fax:919-465-4427
Practice Address - Street 1:103 FREHOLD CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-7372
Practice Address - Country:US
Practice Address - Phone:919-465-4424
Practice Address - Fax:919-465-4427
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301648Medicaid
NC147PEOtherBLUE CROSS BLUE SHIELD