Individual
CRYSTAL PONDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
611 31ST ST, WILSON, KS 67490-8740
(785) 658-2505
Mailing address
1226 E ELLSWORTH AVE, SALINA, KS 67401-8309
(785) 404-6622
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
T-03094
KS
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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