Individual
MRS. CRYSTAL LYNN STEPHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR
Contact information
Practice address
12803 LENOVER ST, DILLSBORO, IN 47018-9418
(812) 432-5226
Mailing address
12803 LENOVER ST, DILLSBORO, IN 47018-9418
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31005266A
IN
225XP0019X
Physical Rehabilitation Occupational Therapist
31005266A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100273840
—
IN
Enumeration date
11/28/2012
Last updated
11/28/2012
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