Healthcare Provider Details

I. General information

NPI: 1184913428
Provider Name (Legal Business Name): KRISTA JOY CROSBY OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 BURLEY RD
ROCHESTER NY
14612-5708
US

IV. Provider business mailing address

180 BURLEY RD
ROCHESTER NY
14612-5708
US

V. Phone/Fax

Practice location:
  • Phone: 585-957-2927
  • Fax:
Mailing address:
  • Phone: 585-957-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006654-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: