Provider Demographics
NPI:1881132645
Name:BARCHACKY, CRYSTAL (MSOT, OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:BARCHACKY
Suffix:
Gender:F
Credentials:MSOT, OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 KAPLON CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-1655
Mailing Address - Country:US
Mailing Address - Phone:910-723-6463
Mailing Address - Fax:
Practice Address - Street 1:820 KAPLON CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-1655
Practice Address - Country:US
Practice Address - Phone:910-723-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist