Healthcare Provider Details

I. General information

NPI: 1912456096
Provider Name (Legal Business Name): CHRISTOPHER ROBERT VIRGIN MS, OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CROSSLAKE DR
EVANSVILLE IN
47715-8198
US

IV. Provider business mailing address

PO BOX 5629
EVANSVILLE IN
47716-5629
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-1558
  • Fax: 812-474-2296
Mailing address:
  • Phone: 502-882-9379
  • Fax: 502-805-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT19626
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009576
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006323A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: