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General NPI Number Information
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NPI Number | 1720392186
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Entity Type | Individual
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Provider Name | CHRISTIE ROE PRIDE M.ED., OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 173 KEITH ST STE 3
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City | WARRENTON
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State | VA
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Zip | 20186-3257
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Country | US
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Telephone | 888-271-0505
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Fax |
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Provider Business Mailing Address
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Address Line | 10603 LEES MILL RD
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City | WARRENTON
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State | VA
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Zip | 20186-8449
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Country | US
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Telephone | 540-422-3016
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119 000300
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License Number State | VA
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