Provider Demographics
NPI:1558863399
Name:REID-BALTZ, CRYSTAL (OTR/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:REID-BALTZ
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 1:105 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9342
Mailing Address - Country:US
Mailing Address - Phone:203-273-0052
Mailing Address - Fax:
Practice Address - Street 1:105 STRATFORD RD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369-9342
Practice Address - Country:US
Practice Address - Phone:203-273-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist