Basic Information
| Provider Information | |||||||||
| NPI: | 1639552177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUCKRAN | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002434556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 SEARLES RD | ||||||||
| Address2: | |||||||||
| City: | WINDHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030871203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038901290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2015 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0886 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 875 | MA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.