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NPI Code Detail

MEDICARE: MRS. CASSANDRA ELIZABETH CRUTCHFIELD

MEDICARE: MRS. CASSANDRA ELIZABETH CRUTCHFIELD
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1710018783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CASSANDRA ELIZABETH CRUTCHFIELD
Provider Business Mailing Address
First Line : 6239 S EAST ST STE I
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-2088
Country : US
Telephone Number : 317-270-0522
Fax Number : 800-675-1132
Provider Business Practice Location Address
First Line : 6239 S EAST ST STE I
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-2088
Country : US
Telephone Number : 317-270-0522
Fax Number : 317-791-9001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 08/09/2024

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