Provider Demographics
NPI:1982890604
Name:CHRISTIANSEN, DEBRA ANN (COTA)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2115
Mailing Address - Country:US
Mailing Address - Phone:631-226-4331
Mailing Address - Fax:631-226-4331
Practice Address - Street 1:940 N ERIE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2115
Practice Address - Country:US
Practice Address - Phone:631-226-4331
Practice Address - Fax:631-226-4331
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002936-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant