Provider Demographics
NPI:1538365606
Name:BROWN, CRYSTAL MARIE (OT)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:BROWN CRYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:O T
Mailing Address - Street 1:4827 ESCALON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1621
Mailing Address - Country:US
Mailing Address - Phone:323-293-8776
Mailing Address - Fax:
Practice Address - Street 1:9333 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4640225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist