MEDICARE: LYDIA LEA CHRISTESEN OTR, CHT

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	225XH1200X	Hand Occupational Therapist	6118	AZ
2	225X00000X	Occupational Therapist	5201001462	MI

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	:	1598764755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA LEA CHRISTESEN OTR, CHT

Provider Business Mailing Address
First Line	:	6916 W ROBIN LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5908
Country	:	US
Telephone Number	:	198-998-0849
Fax Number	:

Provider Business Practice Location Address
First Line	:	6916 W ROBIN LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5908
Country	:	US
Telephone Number	:	198-998-0849
Fax Number	:	928-777-9975

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/21/2023

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