Provider Demographics
NPI:1841819026
Name:ISHAQ, CHRISTINA (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ISHAQ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 E MANITOBA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2448
Mailing Address - Country:US
Mailing Address - Phone:414-218-7415
Mailing Address - Fax:
Practice Address - Street 1:1217 E MANITOBA ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2448
Practice Address - Country:US
Practice Address - Phone:414-218-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013482225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics