Basic Information
| Provider Information | |||||||||
| NPI: | 1588865919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELGER | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OTR L NUMBER 0355AZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2238 E GINTER ROAD | ||||||||
| Address2: | SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 95706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205452137 | ||||||||
| FaxNumber: | 5205452120 | ||||||||
| Practice Location | |||||||||
| Address1: | 2238 E GINTER ROAD | ||||||||
| Address2: | SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 95706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205452137 | ||||||||
| FaxNumber: | 5205452120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0355 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 570277 | 05 | AZ | MEDICAID |