1881773166 NPI number — CHRISTA VAN ZYL OT

Table of content: CHRISTA VAN ZYL OT (NPI 1881773166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881773166 NPI number — CHRISTA VAN ZYL OT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN ZYL
Provider First Name:
CHRISTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN ZYL
Provider Other First Name:
HESTER MARIA
Provider Other Middle Name:
CHRISTINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881773166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-329-4211
Provider Business Mailing Address Fax Number:
678-840-2112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 E BUTLER RD BLDG E2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAULDIN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29662-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-329-4211
Provider Business Practice Location Address Fax Number:
678-840-2112
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1412 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)