MEDICARE: CHRISTINA RENEE OTOOLE MA SLP-CCC

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	235Z00000X	Speech-Language Pathologist	12364	OR

General Provider Information

NPI Number	:	1932379799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA RENEE OTOOLE MA SLP-CCC

Provider Business Mailing Address
First Line	:	2645 ELLEN LN NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-1069
Country	:	US
Telephone Number	:	971-719-9048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 ELLEN LN NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-1069
Country	:	US
Telephone Number	:	971-719-9048
Fax Number	:

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

Provider Enumeration Date	:	03/08/2008
Last Update Date	:	07/03/2025

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