Crystal Mary Dirks, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057004588 Issued in IL

Practice address

211 75TH St
Burr Ridge, IL 60527

Phone

(630) 230-1170

NPI assigned

Jul 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Crystal Mary Pedziewiatr Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593648000000",
    "number": "1023635364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1S221 EUCLID AVE",
            "city": "VILLA PARK",
            "state": "IL",
            "postal_code": "601813902",
            "telephone_number": "630-995-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 75TH ST",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "60527",
            "telephone_number": "630-230-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIRKS",
        "first_name": "CRYSTAL",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-02",
        "last_updated": "2020-07-02",
        "certification_date": "2020-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057004588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "PEDZIEWIATR",
            "middle_name": "MARY",
            "prefix": "MISS",
            "credential": "COTA/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cynthia Anne Digiacomo
• Shea Dignan
• Dik Drug Co
• Valerie Andrea Dipietro, LCSW
• Patricia Michelle Dirilten, LCSW
• Maria Ramos Dizon, P.T.
• Dochas
• Dyenina Daleon Donnelly, FNP-BC
• Candace Douglas-Sterling
• Maria Dowell, MD

• Occupational Therapy Assistant in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.