Provider Demographics
NPI:1861525479
Name:CRESPI, SUSAN CAROL (OTR)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:CRESPI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CALLE PO AEPI
Mailing Address - Street 2:NYE BILINGUAL EARLY CHILDHOOD CENTER
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7767
Mailing Address - Country:US
Mailing Address - Phone:505-467-4600
Mailing Address - Fax:
Practice Address - Street 1:3200 CALLE PO AEPI
Practice Address - Street 2:NYE BILINGUAL EARLY CHILDHOOD CENTER
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-7767
Practice Address - Country:US
Practice Address - Phone:505-467-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDO295Medicaid