Provider Demographics
NPI:1861678146
Name:CLOUTIER, CRYSTAL (COTA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 PRICE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-2523
Mailing Address - Country:US
Mailing Address - Phone:903-263-2285
Mailing Address - Fax:
Practice Address - Street 1:2009 PRICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654
Practice Address - Country:US
Practice Address - Phone:903-263-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210113224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant