Individual
KRYSTAL LEE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
719 S MACON ST, BALTIMORE, MD 21224-4433
(540) 589-7979
Mailing address
719 S MACON ST, BALTIMORE, MD 21224-4433
(540) 589-7979
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119004077
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119004077
COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS
VA
01
—
C-642-478-497-159
MD DRIVER'S LICENSE
MD
Enumeration date
10/27/2010
Last updated
04/02/2014
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