Provider Demographics
NPI:1992205082
Name:MCCRAY, CRYSTAL (LMT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 HAMILTON AVE STE 6D
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2000
Mailing Address - Country:US
Mailing Address - Phone:513-208-3564
Mailing Address - Fax:
Practice Address - Street 1:6240 HAMILTON AVE STE 6D
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2000
Practice Address - Country:US
Practice Address - Phone:513-208-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NPCN-16998-6532246RP1900X
OH33.023943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy