MEDICARE: LETECIA A CRAWFORD CPT

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	171W00000X	Contractor	T118922	CA

General Provider Information

NPI Number	:	1548601065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETECIA A CRAWFORD CPT

Provider Business Mailing Address
First Line	:	2458 CALAMARI COURT
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-343-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2458 CALAMARI CT
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9337
Country	:	US
Telephone Number	:	843-343-0331
Fax Number	:

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	07/12/2013

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