Provider Demographics
NPI:1215113626
Name:RIEDL, CHRISTINA JEAN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:JEAN
Last Name:RIEDL
Suffix:
Gender:F
Credentials: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:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1180
Mailing Address - Country:US
Mailing Address - Phone:508-946-1889
Mailing Address - Fax:
Practice Address - Street 1:389 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4995
Practice Address - Country:US
Practice Address - Phone:508-997-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17Other17