Provider Demographics
NPI:1912962820
Name:HUDDLESTON, CHRISTA I (OT)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:I
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 CORPORATE CENTER LOOP SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5952
Mailing Address - Country:US
Mailing Address - Phone:360-455-8155
Mailing Address - Fax:360-455-1655
Practice Address - Street 1:5210 CORPORATE CENTER CT. S.E.
Practice Address - Street 2:SUITE D
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503
Practice Address - Country:US
Practice Address - Phone:360-455-8155
Practice Address - Fax:360-455-1655
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X
WAOT00001210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3456HUOtherREGENCE BLUE SHIELD
WA710883456-98503-A002OtherTRICARE
WA8439135Medicaid
WA7029729OtherAETNA
WA0202611OtherDEPT. OF LABOR & INDUSTRY
WA8937988OtherL&I CRIME VICTIMS
WAG8856957Medicare PIN
WA0202611OtherDEPT. OF LABOR & INDUSTRY