Provider Demographics
NPI:1316282643
Name:SPANGENBERG, CHRISTINA MARIE
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SPANGENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SOUTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-9748
Mailing Address - Country:US
Mailing Address - Phone:862-266-4677
Mailing Address - Fax:
Practice Address - Street 1:714 S LAKE DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3473
Practice Address - Country:US
Practice Address - Phone:803-642-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00599700225X00000X
SC.5201225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist