Healthcare Provider Details

I. General information

NPI: 1831766153
Provider Name (Legal Business Name): JASON CRAWFORD OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2021
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 W CHARLESTON BLVD
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

3451 DESERT CLIFF ST UNIT 104
LAS VEGAS NV
89129-8619
US

V. Phone/Fax

Practice location:
  • Phone: 415-602-8334
  • Fax:
Mailing address:
  • Phone: 415-602-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number18704
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License NumberOT-3193
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: