Provider Demographics
NPI:1316175425
Name:JANSEN VAN VUUREN, CHRISTA MARIA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:MARIA
Last Name:JANSEN VAN VUUREN
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 1:5145 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1641
Mailing Address - Country:US
Mailing Address - Phone:863-709-0547
Mailing Address - Fax:863-709-0547
Practice Address - Street 1:4240 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3113
Practice Address - Country:US
Practice Address - Phone:863-607-5939
Practice Address - Fax:863-644-4202
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 4846225XG0600X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology