Healthcare Provider Details

I. General information

NPI: 1831577634
Provider Name (Legal Business Name): CHRISTA ROSE SCHESTAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ELM ST
ENFIELD CT
06082-3700
US

IV. Provider business mailing address

113 ELM ST
ENFIELD CT
06082-3700
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-5196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number6870
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTL36604
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: