Provider Demographics
NPI:1699965954
Name:MERCHANT, CHRISTINA LYNN ROCKER (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LYNN ROCKER
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:568 BLUE RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-364-5462
Mailing Address - Fax:706-364-5263
Practice Address - Street 1:568 BLUE RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-364-5462
Practice Address - Fax:706-364-5263
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004596225X00000X
CO1-10-6881103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176225AMedicaid