Provider Demographics
NPI:1679688121
Name:BOYD, CRYSTAL MONIQUE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MONIQUE
Last Name:BOYD
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 1:3416 ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4218
Mailing Address - Country:US
Mailing Address - Phone:216-295-1504
Mailing Address - Fax:
Practice Address - Street 1:2400 HUDSON AURORA RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2322
Practice Address - Country:US
Practice Address - Phone:330-653-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.006346225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist