Provider Demographics
NPI:1164812616
Name:HAND, CRYSTAL (COTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HAND
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 DANBURY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4438
Mailing Address - Country:US
Mailing Address - Phone:800-278-0332
Mailing Address - Fax:800-970-5001
Practice Address - Street 1:64 DANBURY RD STE 100
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4438
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:800-970-5001
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1229224Z00000X
TX212601224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1041937OtherNBCOT CERTIFICATION
NV1229OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE
TX212601OtherOCCUPATIONAL THERAPY ASSISTANT LICENSE