Provider Demographics
NPI:1346653839
Name:SALAMAT, CRISMAE OLAY
Entity Type:Individual
Prefix:
First Name:CRISMAE
Middle Name:OLAY
Last Name:SALAMAT
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 1:8526 W MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6706
Mailing Address - Country:US
Mailing Address - Phone:443-808-3878
Mailing Address - Fax:
Practice Address - Street 1:8526 W MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-6706
Practice Address - Country:US
Practice Address - Phone:443-808-3878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07075225X00000X
AZOTH-006928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist