Provider Demographics
NPI:1902077209
Name:MARTUCCI, CHRISTINE M (OT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:MARTUCCI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 WRIGHTSVILLE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6256
Mailing Address - Country:US
Mailing Address - Phone:910-679-8385
Mailing Address - Fax:910-679-8387
Practice Address - Street 1:3901 WRIGHTSVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6256
Practice Address - Country:US
Practice Address - Phone:910-679-8385
Practice Address - Fax:910-679-8387
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00450000225100000X
NC9237225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ122671PCVMedicare PIN