Provider Demographics
NPI:1699922682
Name:GRAHAM, CHRISTINA ELAINE (MOTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ELAINE
Other - Last Name:ARAGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:775 GATEWAY DR SE APT 1107
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4043
Mailing Address - Country:US
Mailing Address - Phone:505-553-5864
Mailing Address - Fax:
Practice Address - Street 1:50 MULBERRY TREE ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1274
Practice Address - Country:US
Practice Address - Phone:505-553-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1576225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist