Provider Demographics
NPI:1881773166
Name:VAN ZYL, CHRISTA (OT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:VAN ZYL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:HESTER MARIA
Other - Middle Name:CHRISTINA
Other - Last Name:VAN ZYL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-0369
Mailing Address - Country:US
Mailing Address - Phone:864-329-4211
Mailing Address - Fax:678-840-2112
Practice Address - Street 1:213 E BUTLER RD BLDG E2
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2172
Practice Address - Country:US
Practice Address - Phone:864-329-4211
Practice Address - Fax:678-840-2112
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist