Provider Demographics
NPI:1093525933
Name:DUFFANY, KRYSTA KAYE (CTRS)
Entity type:Individual
Prefix:MRS
First Name:KRYSTA
Middle Name:KAYE
Last Name:DUFFANY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:MISS
Other - First Name:KRYSTA
Other - Middle Name:KAYE
Other - Last Name:KOZLOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:2886 GRASS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-1804
Mailing Address - Country:US
Mailing Address - Phone:313-999-1866
Mailing Address - Fax:
Practice Address - Street 1:2800 LIVERNOIS
Practice Address - Street 2:BLDG E STE 162
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:313-999-1866
Practice Address - Fax:248-528-6667
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
49674225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist