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General NPI Number Information
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NPI Number | 1679287684
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Entity Type | Individual
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Provider Name | CHRISTINA DANIELLE VAN METER
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Gender | Female
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Dates
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Enumeration Date | 01/13/2023
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 4603 TIMBERWALK CT
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City | LA GRANGE
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State | KY
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Zip | 40031-6746
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Country | US
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Telephone | 888-288-3534
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Fax |
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Provider Business Mailing Address
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Address Line | 3937 STATON RIDGE RD
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City | METROPOLIS
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State | IL
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Zip | 62960-3734
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Country | US
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Telephone | 618-638-4698
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 282306
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License Number State | KY
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