Provider Demographics
NPI:1144508052
Name:RICHARDSON, CHRISTINE MARY (COTA/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-9554
Mailing Address - Country:US
Mailing Address - Phone:610-856-6910
Mailing Address - Fax:
Practice Address - Street 1:227 EVERGREEN RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3143
Practice Address - Country:US
Practice Address - Phone:610-718-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007093224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1760469472Medicare UPIN