Provider Demographics
NPI:1255929774
Name:WATERS, CHRISTOPHER DARIUS (OT/R)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DARIUS
Last Name:WATERS
Suffix:
Gender:M
Credentials:OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 BUCKINGHAM PKWY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7223
Mailing Address - Country:US
Mailing Address - Phone:310-614-5481
Mailing Address - Fax:
Practice Address - Street 1:6124 BUCKINGHAM PKWY UNIT 204
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7223
Practice Address - Country:US
Practice Address - Phone:310-614-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21399225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist