Provider Demographics
NPI:1992313449
Name:CRAYMER, MALINDA JO (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:JO
Last Name:CRAYMER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MRS
Other - First Name:MALINDA
Other - Middle Name:JO
Other - Last Name:CRAYMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:SELECT REHAB LLC
Mailing Address - Street 2:2600 COMPASS RD
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:616-638-7528
Mailing Address - Fax:
Practice Address - Street 1:900 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2146
Practice Address - Country:US
Practice Address - Phone:616-296-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202002444224ZL0004X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No224ZL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantLow Vision