Provider Demographics
NPI:1689496556
Name:BEAGLE, CHRISTINA GAYLE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GAYLE
Last Name:BEAGLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2961 WALLING RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-9415
Mailing Address - Country:US
Mailing Address - Phone:850-454-8842
Mailing Address - Fax:
Practice Address - Street 1:2961 WALLING RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-9415
Practice Address - Country:US
Practice Address - Phone:850-454-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10443225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist