Provider Demographics
NPI:1215342464
Name:KOTERBA, CHRISTINE (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KOTERBA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:HAJEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 CHILDREN'S DRIVE
Mailing Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-722-4700
Mailing Address - Fax:614-722-4718
Practice Address - Street 1:700 CHILDREN'S DRIVE
Practice Address - Street 2:DEPARTMENT OF PSYCHOLOGY
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205
Practice Address - Country:US
Practice Address - Phone:614-722-4700
Practice Address - Fax:614-722-4718
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid