Healthcare Provider Details

I. General information

NPI: 1609432319
Provider Name (Legal Business Name): CHRISTINA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PEARLCROFT RD
CHERRY HILL NJ
08034-3334
US

IV. Provider business mailing address

125 HURFFVILLE GRENLOCH RD
SEWELL NJ
08080-3902
US

V. Phone/Fax

Practice location:
  • Phone: 609-509-2388
  • Fax: 267-790-0402
Mailing address:
  • Phone: 609-319-4154
  • Fax: 267-790-0402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number46TR00867900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: