Provider Demographics
NPI:1053199323
Name:DIAZ, CHRISTA MARIE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HILLBILLY LN
Mailing Address - Street 2:
Mailing Address - City:FRIEDENS
Mailing Address - State:PA
Mailing Address - Zip Code:15541-7810
Mailing Address - Country:US
Mailing Address - Phone:814-521-0260
Mailing Address - Fax:
Practice Address - Street 1:706 EISENHOWER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3527
Practice Address - Country:US
Practice Address - Phone:814-266-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist