Provider Demographics
NPI:1962186007
Name:JESSICA CRAFTON LLC
Entity type:Organization
Organization Name:JESSICA CRAFTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CARRIE
Authorized Official - Last Name:CRAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-877-8785
Mailing Address - Street 1:7750 THORNAPPLE BAYOU DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9715
Mailing Address - Country:US
Mailing Address - Phone:219-877-8785
Mailing Address - Fax:
Practice Address - Street 1:1005 LAKE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1536
Practice Address - Country:US
Practice Address - Phone:616-274-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty