Provider Demographics
NPI:1114187994
Name:STULTZ, CRYSTAL MICHELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:STULTZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 MURILLO WAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-5509
Mailing Address - Country:US
Mailing Address - Phone:501-730-2042
Mailing Address - Fax:
Practice Address - Street 1:74 MURILLO WAY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-5509
Practice Address - Country:US
Practice Address - Phone:501-730-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-14
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2172225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167726721Medicaid