1730305731 NPI number — MS. CINDY CRABTREE DEMENDOZA OTR/L

Table of content: MS. CINDY CRABTREE DEMENDOZA OTR/L (NPI 1730305731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730305731 NPI number — MS. CINDY CRABTREE DEMENDOZA OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMENDOZA
Provider First Name:
CINDY
Provider Middle Name:
CRABTREE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRABTREE
Provider Other First Name:
CINDY
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730305731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
561 N LACLEDE STATION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER GROVES
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63119-2048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-475-5115
Provider Business Mailing Address Fax Number:
314-475-5115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N 11TH ST
Provider Second Line Business Practice Location Address:
MEDICAID DEPARTMENT
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63101-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-345-2535
Provider Business Practice Location Address Fax Number:
314-345-2653
Provider Enumeration Date:
04/18/2007

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: 225XP0200X , with the licence number:  996185 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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