MEDICARE: CRYSTAL MCCRAY 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	246RP1900X	Phlebotomy Technician	NPCN-16998-6532
2	225700000X	Massage Therapist	33.023943	OH

General Provider Information

NPI Number	:	1992205082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MCCRAY LMT

Provider Business Mailing Address
First Line	:	6240 HAMILTON AVE STE 6D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2000
Country	:	US
Telephone Number	:	513-208-3564
Fax Number	:

Provider Business Practice Location Address
First Line	:	6240 HAMILTON AVE STE 6D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2000
Country	:	US
Telephone Number	:	513-208-3564
Fax Number	:

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

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	11/26/2023

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