MEDICARE: CRYSTAL JANE HOAK LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	33.022007	OH

General Provider Information

NPI Number	:	1366222614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL JANE HOAK LMT

Provider Business Mailing Address
First Line	:	3130 CENTRAL PARK DR W STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1088
Country	:	US
Telephone Number	:	419-841-9622
Fax Number	:	419-843-8288

Provider Business Practice Location Address
First Line	:	3130 CENTRAL PARK DR W STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-1088
Country	:	US
Telephone Number	:	419-841-9622
Fax Number	:	419-843-8288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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