Provider Demographics
NPI:1538240213
Name:GRADEN, CHRISTINE R (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:R
Last Name:GRADEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15853 QUEEN ANNES LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-5940
Mailing Address - Country:US
Mailing Address - Phone:406-360-2068
Mailing Address - Fax:406-777-5621
Practice Address - Street 1:901 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3600
Practice Address - Country:US
Practice Address - Phone:406-360-2068
Practice Address - Fax:406-777-5621
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT944225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT944OtherOCCUPATIONAL THERAPY LISC
MT3401836Medicaid
MT662570OtherMT BLUE CROSS BLUE SHIELD