Provider Demographics
NPI:1013118785
Name:AMELANG, CRYSTAL LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LYNN
Last Name:AMELANG
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:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1077
Mailing Address - Country:US
Mailing Address - Phone:858-248-7824
Mailing Address - Fax:
Practice Address - Street 1:1210 WILHELMINA RISE
Practice Address - Street 2:SUITE B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3287
Practice Address - Country:US
Practice Address - Phone:858-248-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT8367225XP0200X
HI950225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics