MEDICARE: MRS. SUSAN TODD CRAWFORD OTR L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	660	SC

General Provider Information

NPI Number	:	1548342991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN TODD CRAWFORD OTR L

Provider Business Mailing Address
First Line	:	105 TRELLIS CT
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-8073
Country	:	US
Telephone Number	:	803-957-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 W MAIN ST STE 205
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2500
Country	:	US
Telephone Number	:	803-358-6115
Fax Number	:	803-358-6117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/21/2020

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