Healthcare Provider Details

I. General information

NPI: 1215342464
Provider Name (Legal Business Name): CHRISTINE KOTERBA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE HAJEK

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDREN'S DRIVE DEPARTMENT OF PSYCHOLOGY
COLUMBUS OH
43205
US

IV. Provider business mailing address

700 CHILDREN'S DRIVE DEPARTMENT OF PSYCHOLOGY
COLUMBUS OH
43205
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4700
  • Fax: 614-722-4718
Mailing address:
  • Phone: 614-722-4700
  • Fax: 614-722-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: