Provider Demographics
NPI:1437978111
Name:GALLIE-WEISS, CHRISTA MICHELLE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MICHELLE
Last Name:GALLIE-WEISS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16740 DAVIDSON CONCORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8746
Mailing Address - Country:US
Mailing Address - Phone:704-801-9200
Mailing Address - Fax:
Practice Address - Street 1:16740 DAVIDSON CONCORD RD STE 200
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8746
Practice Address - Country:US
Practice Address - Phone:704-801-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1936225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health