Provider Demographics
NPI:1447592886
Name:MONTROY, CHRYSTAL MARIE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:MARIE
Last Name:MONTROY
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 1:4851 E 50TH ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IL
Mailing Address - Zip Code:62367-2430
Mailing Address - Country:US
Mailing Address - Phone:309-337-4125
Mailing Address - Fax:
Practice Address - Street 1:8 DOCTORS LN
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3310
Practice Address - Country:US
Practice Address - Phone:309-833-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002566224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant