Healthcare Provider Details

I. General information

NPI: 1992205082
Provider Name (Legal Business Name): CRYSTAL MCCRAY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 11/26/2023
Certification Date: 11/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 HAMILTON AVE STE 6D
CINCINNATI OH
45224-2000
US

IV. Provider business mailing address

6240 HAMILTON AVE STE 6D
CINCINNATI OH
45224-2000
US

V. Phone/Fax

Practice location:
  • Phone: 513-208-3564
  • Fax:
Mailing address:
  • Phone: 513-208-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.023943
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNPCN-16998-6532
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: