Healthcare Provider Details

I. General information

NPI: 1366952038
Provider Name (Legal Business Name): CHRISTY RAE VINEBERG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTY FAVINGER

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

4002 N WARNER RD
LAFAYETTE HILL PA
19444-1409
US

V. Phone/Fax

Practice location:
  • Phone: 864-244-3626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: