Individual
CRYSTAL D DIXON-LARGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
111 DAVIS STUART ROAD, RONCEVERTE, WV 24970
(304) 647-3987
(304) 647-3990
Mailing address
111 DAVIS STUART ROAD, RONCEVERTE, WV 24970
(304) 647-3987
(304) 647-3990
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
WV897
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7501097000
—
WV
Enumeration date
10/31/2006
Last updated
07/09/2007
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