Provider Demographics
NPI:1770823833
Name:KOSTER, CRYSTAL (MOT/L)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:KOSTER
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:MISS
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:SEBALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT/L
Mailing Address - Street 1:12525 ROCKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLEAR SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:21722-1532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2085 WAYNE RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-8586
Practice Address - Country:US
Practice Address - Phone:717-709-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015564225X00000X
MD06296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist