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General NPI Number Information
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NPI Number | 1558096180
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Entity Type | Individual
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Provider Name | CRYSTAL HICKMAN LMT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 22 W PADONIA RD STE B229
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City | TIMONIUM
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State | MD
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Zip | 21093-2247
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Country | US
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Telephone | 443-574-5985
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Fax |
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Provider Business Mailing Address
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Address Line | 6 BEEHIVE PL APT D
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-3738
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Country | US
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Telephone | 571-394-1124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M06019
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License Number State | MD
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