Provider Demographics
NPI:1992958458
Name:KANARICK, CHRISTINE DIXON (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:DIXON
Last Name:KANARICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:RENEE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8716
Mailing Address - Country:US
Mailing Address - Phone:917-626-3396
Mailing Address - Fax:
Practice Address - Street 1:10 SUTTON DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8716
Practice Address - Country:US
Practice Address - Phone:917-626-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014483-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics