Crystal L Davis, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00019024 Issued in WA

Practice address

139 1St Ave. SW
Castle Rock, WA 98611

Phone

(360) 274-2353

Fax

(360) 274-2354

NPI assigned

Jan 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 identifiers 2

Other names 1

• Crystal L Hottell 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": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417002064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 PAINE RD",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986118708",
            "telephone_number": "360-274-2353",
            "fax_number": "360-274-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 1ST AVE. SW",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "98611",
            "telephone_number": "360-274-2353",
            "fax_number": "360-274-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CRYSTAL",
        "middle_name": "L",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00019024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN SPECIALTY HEALTH",
            "identifier": "1055113",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "3804HO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "HOTTELL",
            "middle_name": "L",
            "credential": "LMP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Cowlitz County Fire District 6
• Cowlitz Family Health Center (Family Health Center Castle Rock Clinic)
• Cowlitz Family Health Center
• Lily Barbosa Crocco, DMD
• Arika Davidson, RND
• Amber Delagrange, SUDP
• Anne Denson, RN
• Tonya Dorough
• Bozena Drabik, SUDP
• Laverna Lee Dubois, RDH

• Massage Therapist in Castle Rock, WA
• Providers in Castle Rock, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.