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General NPI Number Information
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NPI Number | 1376651612
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Entity Type | Individual
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Provider Name | CHRISTINE BANAS SORIANO
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 4407 AMARILLO ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-5702
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Country | US
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Telephone | 870-532-2229
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Fax | 870-532-8237
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Provider Business Mailing Address
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Address Line | 27575 N SILVERADO RANCH RD
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City | PEORIA
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State | AZ
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Zip | 85383-8819
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Country | US
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Telephone | 480-823-9291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR 1812
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License Number State | AR
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