Provider Demographics
NPI:1144662669
Name:CONNER, CRYSTAL YVONNE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:YVONNE
Last Name:CONNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:624 US HIGHWAY 17 S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-8660
Mailing Address - Country:US
Mailing Address - Phone:910-329-4445
Mailing Address - Fax:910-329-4444
Practice Address - Street 1:624 US HIGHWAY 17 S
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8660
Practice Address - Country:US
Practice Address - Phone:910-329-4445
Practice Address - Fax:910-329-4444
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5057224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant