1386043669 NPI number — MS. KATHLEEN SUSAN CRIM OCCUPATIONAL THERAPI

Table of content: MS. KATHLEEN SUSAN CRIM OCCUPATIONAL THERAPI (NPI 1386043669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386043669 NPI number — MS. KATHLEEN SUSAN CRIM OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRIM
Provider First Name:
KATHLEEN
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386043669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 SHEPARD ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTABULAR
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-992-0163
Provider Business Mailing Address Fax Number:
440-228-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 SOUTH CHESTNUT STREET
Provider Second Line Business Practice Location Address:
JEFFERSON REHAB AND WELLNESS
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-576-0043
Provider Business Practice Location Address Fax Number:
440-576-0187
Provider Enumeration Date:
08/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT-005575 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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