Provider Demographics
NPI:1366766107
Name:NELSON, CRYSTAL (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1400
Mailing Address - Country:US
Mailing Address - Phone:701-532-2222
Mailing Address - Fax:701-552-7211
Practice Address - Street 1:345 11TH ST W
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-1400
Practice Address - Country:US
Practice Address - Phone:701-532-2222
Practice Address - Fax:701-552-7211
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10822083X0100X, 225XP0019X, 225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation