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General NPI Number Information
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NPI Number | 1609166578
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Entity Type | Individual
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Provider Name | CRYSTAL LYNN DIAZ OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 09/13/2017
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Provider Practice Location Address
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Address Line | 60 E 104TH ST 3C
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City | NEW YORK
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State | NY
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Zip | 10029-4524
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Country | US
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Telephone | 212-933-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 340 BEACH 102ND STREET
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694
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Country | US
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Telephone | 570-856-5953
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 007835-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 021885
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License Number State | NY
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