Provider Demographics
NPI:1366077802
Name:HUBBARD, CRYSTAL GAYLE
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:GAYLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 FISHER CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7456
Mailing Address - Country:US
Mailing Address - Phone:606-627-2354
Mailing Address - Fax:
Practice Address - Street 1:2801 US HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2069
Practice Address - Country:US
Practice Address - Phone:606-627-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist