MEDICARE: CORRIN A CRISWELL OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	888	CO

General Provider Information

NPI Number	:	1093959421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRIN A CRISWELL OT

Provider Business Mailing Address
First Line	:	7606 N UNION BLVD STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3873
Country	:	US
Telephone Number	:	719-667-0666
Fax Number	:

Provider Business Practice Location Address
First Line	:	7606 N UNION BLVD STE F
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3873
Country	:	US
Telephone Number	:	719-667-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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