Basic Information
| Provider Information | |||||||||
| NPI: | 1689870461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICK | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4008 N GRIMES ST | ||||||||
| Address2: | PMB 160 | ||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882400903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5198275831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8820 HORIZON BLVD NE | ||||||||
| Address2: | REHAB DEPARTMENT | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871131689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058231885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2233 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.