Active NPI
Crystal D Bedford, OT
- Occupational Therapist
- Tucker, GA
National Provider Identifier
1336122456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT006250
- Practice address
- 1979 Lakeside Pkwy
Ste 800
Tucker, GA 30084-5935 - Phone
- (770) 325-0310
- NPI assigned
- Nov 22, 2005
- Last updated
- Apr 30, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT006250 | OH | Primary |
Addresses
Primary practice location
1979 Lakeside Pkwy
Ste 800
Tucker, GA 30084-5935
Mailing address
1979 Lakeside Pkwy
Ste 800
Tucker, GA 30084-5935
Phone (770) 325-0310
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000351592 | Other | OH | ANTHEM BLUE CROSS |
Other names 1
- Crystal D Shaw
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT006250 | OH | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241049600000",
"number": "1336122456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1979 LAKESIDE PKWY",
"address_2": "STE 800",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845935",
"telephone_number": "770-325-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1979 LAKESIDE PKWY",
"address_2": "STE 800",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845935",
"telephone_number": "770-325-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEDFORD",
"first_name": "CRYSTAL",
"middle_name": "D",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-22",
"last_updated": "2009-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OH",
"license": "OT006250",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "000000351592",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CRYSTAL",
"last_name": "SHAW",
"middle_name": "D",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.