Provider Demographics
NPI:1487747028
Name:RIORDAN, CHRISTINA L (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:RIORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1455
Mailing Address - Country:US
Mailing Address - Phone:239-574-7557
Mailing Address - Fax:239-574-1315
Practice Address - Street 1:2328 HANCOCK BRIDGE PKWY STE 103
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1455
Practice Address - Country:US
Practice Address - Phone:239-574-7557
Practice Address - Fax:239-574-1315
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000777A225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00710223OtherRR MEDICARE
000000179535OtherANTHEM HEALTH PLAN
IN200037000Medicaid
IN062110I5Medicare PIN
IN156524Medicare PIN