Provider Demographics
NPI:1316072713
Name:CRANE WELCH, MARY P (OTRL)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:CRANE WELCH
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:18700 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-596-9799
Mailing Address - Fax:714-596-9739
Practice Address - Street 1:18700 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-596-9799
Practice Address - Fax:714-596-9739
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5849225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist