Provider Demographics
NPI:1730865742
Name:ADALINE, CHRISTINE (OTDR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ADALINE
Suffix:
Gender:F
Credentials:OTDR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 JONES LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-7034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2929 TAZEWELL PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1874
Practice Address - Country:US
Practice Address - Phone:615-614-8833
Practice Address - Fax:502-805-1511
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
TN8060225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty