Basic Information
| Provider Information | |||||||||
| NPI: | 1912962820 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HUDDLESTON | ||||||||
| FirstName: | CHRISTA | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5210 CORPORATE CENTER LOOP SE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985035952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604558155 | ||||||||
| FaxNumber: | 3604551655 | ||||||||
| Practice Location | |||||||||
| Address1: | 5210 CORPORATE CENTER CT. S.E. | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604558155 | ||||||||
| FaxNumber: | 3604551655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 04/15/2010 | ||||||||
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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 | 225XH1200X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | OT00001210 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3456HU | 01 | WA | REGENCE BLUE SHIELD | OTHER | 710883456-98503-A002 | 01 | WA | TRICARE | OTHER | 8439135 | 05 | WA | MEDICAID | 7029729 | 01 | WA | AETNA | OTHER | 0202611 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 8937988 | 01 | WA | L&I CRIME VICTIMS | OTHER |