Provider Demographics
NPI:1407481674
Name:LOVELADY, CRYSTAL LANETTE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LANETTE
Last Name:LOVELADY
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 1:1331 W CALLE DEL ENSAYADOR
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-9724
Mailing Address - Country:US
Mailing Address - Phone:805-459-9487
Mailing Address - Fax:
Practice Address - Street 1:1331 W CALLE DEL ENSAYADOR
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9724
Practice Address - Country:US
Practice Address - Phone:805-459-9487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ046791224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant