Individual
CRYSTAL ALCORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
318 E MAIN ST, LAKE CITY, SC 29560-2116
(843) 374-3353
Mailing address
5520 COUNTRY LN, TIMMONSVILLE, SC 29161-8399
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2300
SC
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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