Provider Demographics
NPI:1255509121
Name:SWAIN, CRYSTAL LEA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:LEA
Last Name:SWAIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4564
Mailing Address - Country:US
Mailing Address - Phone:229-888-7688
Mailing Address - Fax:
Practice Address - Street 1:102 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4564
Practice Address - Country:US
Practice Address - Phone:229-888-7688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001009224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant