Provider Demographics
NPI:1093044356
Name:CHRISTY, ELIZABETH JANE (COTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 REXFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-1083
Mailing Address - Country:US
Mailing Address - Phone:260-745-7948
Mailing Address - Fax:
Practice Address - Street 1:2400 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1900
Practice Address - Country:US
Practice Address - Phone:765-747-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001586A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant