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General NPI Number Information
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NPI Number | 1144000985
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Entity Type | Individual
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Provider Name | COLTEN V CREWS OTD, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 2798 S 2ND ST STE A
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City | CABOT
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State | AR
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Zip | 72023-7044
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Country | US
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Telephone | 501-286-6075
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Fax |
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Provider Business Mailing Address
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Address Line | 2798 S 2ND ST STE A
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City | CABOT
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State | AR
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Zip | 72023-7044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR3839
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License Number State | AR
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