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General NPI Number Information
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NPI Number | 1699922682
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Entity Type | Individual
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Provider Name | CHRISTINA ELAINE GRAHAM MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/21/2008
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 50 MULBERRY TREE ST
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City | CHARLES TOWN
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State | WV
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Zip | 25414-1274
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Country | US
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Telephone | 505-553-5864
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Fax |
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Provider Business Mailing Address
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Address Line | 775 GATEWAY DR SE APT 1107
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City | LEESBURG
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State | VA
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Zip | 20175-4043
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Country | US
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Telephone | 505-553-5864
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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 | 1576
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License Number State | WV
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