Provider Demographics
NPI:1275015513
Name:MONTOYA, CRYSTAL ADALIA
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ADALIA
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 N HOLIDAY HILL RD APT 1807
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-3028
Mailing Address - Country:US
Mailing Address - Phone:432-425-4852
Mailing Address - Fax:
Practice Address - Street 1:1100 BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:432-756-2841
Practice Address - Fax:432-756-2904
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211039224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant