Provider Demographics
NPI:1174874234
Name:BARRETT, CHRISTA MARIE (OT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1844
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1844
Mailing Address - Country:US
Mailing Address - Phone:864-482-0064
Mailing Address - Fax:864-482-0081
Practice Address - Street 1:1019 TIGER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2913
Practice Address - Country:US
Practice Address - Phone:864-654-0431
Practice Address - Fax:864-654-0799
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist