Provider Demographics
NPI:1871730465
Name:DOUGLAS, CHRISTINA M (OTD, MOT, OTR)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:OTD, MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:RCS PROVIDER ENROLLMENT
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:4870 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4432
Practice Address - Country:US
Practice Address - Phone:765-254-9717
Practice Address - Fax:765-254-9739
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004751A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist