Provider Demographics
NPI:1205662251
Name:OFFHAUS, CRYSTAL M
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:M
Last Name:OFFHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:M
Other - Last Name:OLIVEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5281 CHELAN CV
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5514
Mailing Address - Country:US
Mailing Address - Phone:561-722-2272
Mailing Address - Fax:
Practice Address - Street 1:5281 CHELAN CV
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5514
Practice Address - Country:US
Practice Address - Phone:561-722-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171WH0202X
225CA2400X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No171WH0202XOther Service ProvidersContractorHome Modifications
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner