Provider Demographics
NPI:1700308350
Name:ROCK, CHRISTINE NICOLE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:ROCK
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 1:65 COUNTRYSIDE LN APT 1
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1321
Mailing Address - Country:US
Mailing Address - Phone:716-998-4907
Mailing Address - Fax:
Practice Address - Street 1:65 COUNTRYSIDE LN APT 1
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1321
Practice Address - Country:US
Practice Address - Phone:716-998-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007618-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant