Provider Demographics
NPI:1083750897
Name:CRAWFORD, COLEEN MARY (OTA)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:MARY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:COLEEN
Other - Middle Name:MARY
Other - Last Name:INDRIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:7221 NUSS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4403
Mailing Address - Country:US
Mailing Address - Phone:361-960-8628
Mailing Address - Fax:
Practice Address - Street 1:7221 NUSS DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4403
Practice Address - Country:US
Practice Address - Phone:361-960-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200732224Z00000X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty