Individual
CRYSTAL LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16 ROYAL AVE, LIVINGSTON, NJ 07039-3122
(973) 207-3117
Mailing address
16 ROYAL AVE, LIVINGSTON, NJ 07039-3122
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46TR00866100
SENSORY GYM
NJ
Enumeration date
01/10/2023
Last updated
01/10/2023
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