Provider Demographics
NPI:1063053940
Name:KRAWCHUCK, CELESTE (MSOT, OTRL)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:KRAWCHUCK
Suffix:
Gender:F
Credentials:MSOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S HEWITT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4594
Mailing Address - Country:US
Mailing Address - Phone:734-544-5561
Mailing Address - Fax:
Practice Address - Street 1:850 S HEWITT RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4594
Practice Address - Country:US
Practice Address - Phone:734-544-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT010810225X00000X
MI5201010540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist