Provider Demographics
NPI:1598197238
Name:CRUTCHER, MARY BETH LONG (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:LONG
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 HIGHLAND SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9462
Mailing Address - Country:US
Mailing Address - Phone:304-667-9388
Mailing Address - Fax:
Practice Address - Street 1:649 HIGHLAND SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9462
Practice Address - Country:US
Practice Address - Phone:304-667-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN312000225X00000X
WV2452225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist