Provider Demographics
NPI:1982970216
Name:PETERS, CHRISTAL KATHERINE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:KATHERINE
Last Name:PETERS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 17TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3422
Mailing Address - Country:US
Mailing Address - Phone:406-579-9567
Mailing Address - Fax:
Practice Address - Street 1:2509 7TH AVE S STE C4
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3031
Practice Address - Country:US
Practice Address - Phone:406-216-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1155225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics