Provider Demographics
NPI:1699390138
Name:CROCKETT, ANNE (OTR/L)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11201 PEPPER RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1201
Mailing Address - Country:US
Mailing Address - Phone:410-790-7704
Mailing Address - Fax:
Practice Address - Street 1:11201 PEPPER RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1201
Practice Address - Country:US
Practice Address - Phone:410-790-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist