Healthcare Provider Details

I. General information

NPI: 1861714735
Provider Name (Legal Business Name): CHRISTINA CHANG CHIAN OTD, OTR/L, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 LIMESTONE RD
CLAREMONT CA
91711-1842
US

IV. Provider business mailing address

184 LIMESTONE RD
CLAREMONT CA
91711-1842
US

V. Phone/Fax

Practice location:
  • Phone: 626-202-7322
  • Fax: 909-626-3282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5325
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number5325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: