Healthcare Provider Details

I. General information

NPI: 1225289887
Provider Name (Legal Business Name): SEBASTIAN J CRAWFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 NEARVIEW AVE
COLUMBIA SC
29223-3614
US

IV. Provider business mailing address

1709 NEARVIEW AVE
COLUMBIA SC
29223-3614
US

V. Phone/Fax

Practice location:
  • Phone: 907-887-1223
  • Fax:
Mailing address:
  • Phone: 907-887-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2924
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: