Provider Demographics
NPI:1861553562
Name:COLLINS-OUTLAND, CHRISTINE M (ACMT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:M
Last Name:COLLINS-OUTLAND
Suffix:
Gender:F
Credentials:ACMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11356 W STUENKEL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8286
Mailing Address - Country:US
Mailing Address - Phone:815-469-9078
Mailing Address - Fax:
Practice Address - Street 1:11356 W STUENKEL RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-8286
Practice Address - Country:US
Practice Address - Phone:815-469-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist