Provider Demographics
NPI:1366715880
Name:CRAIG, JOSHUA APPOLLO (COTA/L)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:APPOLLO
Last Name:CRAIG
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-1929
Mailing Address - Country:US
Mailing Address - Phone:918-619-7583
Mailing Address - Fax:
Practice Address - Street 1:405 N SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-1929
Practice Address - Country:US
Practice Address - Phone:918-619-7583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1059224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant