Individual
CRYSTAL D BEDFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1979 LAKESIDE PKWY, STE 800, TUCKER, GA 30084-5935
(770) 325-0310
Mailing address
1979 LAKESIDE PKWY, STE 800, TUCKER, GA 30084-5935
(770) 325-0310
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006250
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351592
ANTHEM BLUE CROSS
OH
Enumeration date
11/22/2005
Last updated
04/30/2009
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