Provider Demographics
NPI:1770901258
Name:BREWINGTON, KRYSTAL MONIQUE (MS, OTR/L, CPAM)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MONIQUE
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:MS, OTR/L, CPAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT PATRICKS DR
Mailing Address - Street 2:STE 401
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4583
Mailing Address - Country:US
Mailing Address - Phone:301-870-9783
Mailing Address - Fax:301-870-6717
Practice Address - Street 1:7905 MALCOLM RD
Practice Address - Street 2:STE 201
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1749
Practice Address - Country:US
Practice Address - Phone:301-856-0050
Practice Address - Fax:301-856-0518
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06863225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand