Provider Demographics
NPI:1316459951
Name:CRANDALL, MAGDALENA (OT)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BENJAMIN LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2983
Mailing Address - Country:US
Mailing Address - Phone:615-596-8292
Mailing Address - Fax:
Practice Address - Street 1:151 ADAMS LN STE 11
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8320
Practice Address - Country:US
Practice Address - Phone:615-773-1561
Practice Address - Fax:615-773-1564
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid