Healthcare Provider Details

I. General information

NPI: 1881815793
Provider Name (Legal Business Name): MR. CRAIG MICHAEL JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 PALMER AVE STE 2
FALMOUTH MA
02540-5103
US

IV. Provider business mailing address

620 PALMER AVE STE 2
FALMOUTH MA
02540-5103
US

V. Phone/Fax

Practice location:
  • Phone: 508-540-5559
  • Fax: 508-540-5660
Mailing address:
  • Phone: 508-540-5559
  • Fax: 508-540-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00004127
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number1839
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13357
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: