Healthcare Provider Details

I. General information

NPI: 1457560203
Provider Name (Legal Business Name): CHRISTINE KONHZOUA VUE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE KONHZOUA MOUA OTR

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3912 10TH ST SE SUITE 101
PUYALLUP WA
98374-2188
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-4700
  • Fax: 253-848-2284
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1400610
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60002446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: