Basic Information
| Provider Information | |||||||||
| NPI: | 1164812616 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HAND | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 DANBURY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068974438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002780332 | ||||||||
| FaxNumber: | 8009705001 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 DANBURY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068974438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002780332 | ||||||||
| FaxNumber: | 8009705001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2015 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 1229 | NV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | 212601 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1041937 | 01 | MD | NBCOT CERTIFICATION | OTHER | 1229 | 01 | NV | OCCUPATIONAL THERAPY ASSISTANT LICENSE | OTHER | 212601 | 01 | TX | OCCUPATIONAL THERAPY ASSISTANT LICENSE | OTHER |