Provider Demographics
NPI:1215431358
Name:SPAULDLING, CHRISTIANA ELIZABETH (COTA)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:ELIZABETH
Last Name:SPAULDLING
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:ELIZABETH
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 AVIGNON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5120
Mailing Address - Country:US
Mailing Address - Phone:601-605-6777
Mailing Address - Fax:
Practice Address - Street 1:630 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3468
Practice Address - Country:US
Practice Address - Phone:662-473-5947
Practice Address - Fax:601-607-1416
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA3018224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant