Provider Demographics
NPI:1730255720
Name:PORTER, CHRIS E (OT)
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:E
Last Name:PORTER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8540 ARCHIBALD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4662
Mailing Address - Country:US
Mailing Address - Phone:909-987-4242
Mailing Address - Fax:909-987-4277
Practice Address - Street 1:1230 E WASHINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6450
Practice Address - Country:US
Practice Address - Phone:909-825-6716
Practice Address - Fax:909-825-4339
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOT789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03626ZMedicare ID - Type Unspecified