Provider Demographics
NPI:1932237609
Name:O'BRIEN, CRYSTAL L (CMA, LMP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:L
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:CMA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 CENTER BLVD SE # 315
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9096
Mailing Address - Country:US
Mailing Address - Phone:425-888-5060
Mailing Address - Fax:
Practice Address - Street 1:410 E NORTH BEND WAY
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045
Practice Address - Country:US
Practice Address - Phone:425-888-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist