Provider Demographics
NPI:1801932926
Name:FONS, CHRISTINA (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FONS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2246
Mailing Address - Country:US
Mailing Address - Phone:608-299-8181
Mailing Address - Fax:608-299-8281
Practice Address - Street 1:1904 E HUEBBE PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1843
Practice Address - Country:US
Practice Address - Phone:608-931-2550
Practice Address - Fax:608-541-2104
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI977-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL056.007747OtherIL. LICENSE
WI977-026OtherWIS. LICENSE
WI40541800Medicaid
WI40541800Medicaid
WIP06920Medicare UPIN
ILK27628Medicare ID - Type Unspecified