Provider Demographics
NPI:1316338320
Name:CLUTTER, CHRISTINA MARIE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:CLUTTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:621 PONDER PLACE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3121
Mailing Address - Country:US
Mailing Address - Phone:706-310-8383
Mailing Address - Fax:888-528-0136
Practice Address - Street 1:621 PONDER PLACE DR STE 2
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3121
Practice Address - Country:US
Practice Address - Phone:706-310-8383
Practice Address - Fax:888-528-0136
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001807224Z00000X
SC3422224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant