Healthcare Provider Details

I. General information

NPI: 1437543162
Provider Name (Legal Business Name): CHRISTINA O GRAHAM AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA ANN OLIVER

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST # MC52030
HOUSTON TX
77030-2608
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-3249
  • Fax: 832-825-8940
Mailing address:
  • Phone: 682-885-3622
  • Fax: 682-885-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number51511
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51511
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: