MEDICARE: CHRISTY NICOLE ANDERSON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5532	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033242698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY NICOLE ANDERSON OTR/L

Provider Business Mailing Address
First Line	:	1288 COUNTY ROAD M
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-5604
Country	:	US
Telephone Number	:	715-222-1979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1288 COUNTY ROAD M
Second Line	:
City	:	RIVER FALLS
State	:	WI
Zip	:	54022-5604
Country	:	US
Telephone Number	:	715-222-1979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/01/2021

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