Healthcare Provider Details

I. General information

NPI: 1346904737
Provider Name (Legal Business Name): CHRISTIAN GRAGG ALTOMARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 WASHINGTON ST
MOUNT PLEASANT NC
28124-7402
US

IV. Provider business mailing address

1307 DEBBIE ST
KANNAPOLIS NC
28083-3925
US

V. Phone/Fax

Practice location:
  • Phone: 980-290-7311
  • Fax: 704-665-5691
Mailing address:
  • Phone: 704-307-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14551
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: