Healthcare Provider Details

I. General information

NPI: 1508784448
Provider Name (Legal Business Name): ERIN CRISWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAX LANE DR
JACKSON TN
38305-2802
US

IV. Provider business mailing address

901 ENOCHS RD
NEWBERN TN
38059-5231
US

V. Phone/Fax

Practice location:
  • Phone: 731-661-0095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: