Provider Demographics
NPI:1215353156
Name:CROMPTON, MARY (OTR)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CROMPTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-1600
Mailing Address - Country:US
Mailing Address - Phone:512-359-3703
Mailing Address - Fax:877-482-2905
Practice Address - Street 1:3409 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 113
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1600
Practice Address - Country:US
Practice Address - Phone:512-359-3703
Practice Address - Fax:877-482-2905
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist