Provider Demographics
NPI:1740474881
Name:CHMIELAK, CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CHMIELAK
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 1:5067 NIAGARA AVE
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-3077
Mailing Address - Country:US
Mailing Address - Phone:858-866-8133
Mailing Address - Fax:858-999-2002
Practice Address - Street 1:9520 PADGETT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4445
Practice Address - Country:US
Practice Address - Phone:858-866-8133
Practice Address - Fax:858-999-2002
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist