Provider Demographics
NPI:1396137881
Name:CHRISTENSON, CHRISTIE (COTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:
Other - Last Name:MOLDENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5458 TOWN CENTER RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-376-2573
Mailing Address - Fax:
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-376-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213117224Z00000X
FLOTA 15364224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant