Healthcare Provider Details

I. General information

NPI: 1205662251
Provider Name (Legal Business Name): MRS. CRYSTAL M. OFFHAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. CRYSTAL M. OLIVEROS

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5281 CHELAN CV
LAKE WORTH FL
33467-5514
US

IV. Provider business mailing address

5281 CHELAN CV
LAKE WORTH FL
33467-5514
US

V. Phone/Fax

Practice location:
  • Phone: 561-722-2272
  • Fax:
Mailing address:
  • Phone: 561-722-2272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: