Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 950 | HI |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT8367 | CA |
NPI | 1013118785 |
---|---|
Provider Name | Crystal Lynn Amelang |
First Address | Haleiwa, HI 96712-1077 |
Second Address | Honolulu, HI 96816-3287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 23/06/2016 |