Provider Demographics
NPI:1811183072
Name:VANDERGRIFF, CHRYSTAL ANN (MSOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:ANN
Last Name:VANDERGRIFF
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:MISS
Other - First Name:CHRYSTAL
Other - Middle Name:ANN
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35 COTTONWOOD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-9335
Mailing Address - Country:US
Mailing Address - Phone:505-434-1980
Mailing Address - Fax:
Practice Address - Street 1:7540 N 19TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist