Provider Demographics
NPI:1134328206
Name:LEVENSON, CRYSTAL CHRISTINE (COTA/C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CHRISTINE
Last Name:LEVENSON
Suffix:
Gender:F
Credentials:COTA/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W BROADWAY
Mailing Address - Street 2:#1C
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1114
Mailing Address - Country:US
Mailing Address - Phone:818-667-6889
Mailing Address - Fax:
Practice Address - Street 1:17801 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2362
Practice Address - Country:US
Practice Address - Phone:714-777-9666
Practice Address - Fax:714-961-5483
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA1561224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant