Provider Demographics
NPI:1124570619
Name:HALL, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 GROCERY LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:KY
Mailing Address - Zip Code:41601-9047
Mailing Address - Country:US
Mailing Address - Phone:606-259-5102
Mailing Address - Fax:
Practice Address - Street 1:38 GROCERY LN
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:KY
Practice Address - Zip Code:41601-9047
Practice Address - Country:US
Practice Address - Phone:606-259-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist