Provider Demographics
NPI:1326210394
Name:WRIGHT, CRYSTAL C (OTL)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-0031
Mailing Address - Country:US
Mailing Address - Phone:989-345-7151
Mailing Address - Fax:989-345-7153
Practice Address - Street 1:214 W HOUGHTON AVE
Practice Address - Street 2:STE 4
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1220
Practice Address - Country:US
Practice Address - Phone:989-345-7151
Practice Address - Fax:989-345-7153
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist