Provider Demographics
NPI:1497063762
Name:GADDY, CRYSTAL CARTER (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:CARTER
Last Name:GADDY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5868
Mailing Address - Country:US
Mailing Address - Phone:252-364-2806
Mailing Address - Fax:252-364-2863
Practice Address - Street 1:1350 E ARLINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5868
Practice Address - Country:US
Practice Address - Phone:252-364-2806
Practice Address - Fax:252-364-2863
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist