Crystal Marie Brynildsen, MS OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

10264 Issued in CA

Practice address

2409 Levante St
Carlsbad, CA 92009-8020

Phone

(607) 222-4074

NPI assigned

Aug 27, 2012

Last updated

Jul 21, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Crystal Marie Nealis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374364800000",
    "number": "1255689139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4736 ROUTE 467",
            "city": "ROME",
            "state": "PA",
            "postal_code": "188377969",
            "telephone_number": "607-222-4074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2409 LEVANTE ST",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920098020",
            "telephone_number": "607-222-4074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYNILDSEN",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MS OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-27",
        "last_updated": "2013-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CA",
            "license": "10264",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR00439600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "NEALIS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Valerie Rose Brown, M.A.
• Thomas Wayne Bruice, M.D., PH.D.
• Daniel Allen Brunker, PT, DPT
• Beatrice Bruno
• Jessica Bruno, CNS
• Michael Ryan Buchholz
• Kelly Buckley
• Mary Buford
• Annie Bui
• Nancy Belen Bukovac

• Occupational Therapist in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2013; 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.