Provider Demographics
NPI:1053808394
Name:PACE, CHRISTIE LEIGH (OTR)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LEIGH
Last Name:PACE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1919
Mailing Address - Country:US
Mailing Address - Phone:812-455-0612
Mailing Address - Fax:
Practice Address - Street 1:2770 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3242
Practice Address - Country:US
Practice Address - Phone:866-465-5993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006476A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist