Provider Demographics
NPI:1316156870
Name:SEALS, CRYSTAL J (OTRL)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:J
Last Name:SEALS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 KY HIGHWAY 2003
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-9470
Mailing Address - Country:US
Mailing Address - Phone:606-364-8385
Mailing Address - Fax:
Practice Address - Street 1:1033 N HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-5478
Practice Address - Country:US
Practice Address - Phone:606-598-6163
Practice Address - Fax:606-598-6164
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3414225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist