MEDICARE: MARISSA CRAHAN

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	2255A2300X	Athletic Trainer	2023000948	MO

General Provider Information

NPI Number	:	1902287014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA CRAHAN

Provider Business Mailing Address
First Line	:	3241 WILLING AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-3835
Country	:	US
Telephone Number	:	817-791-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	5069 BARTER ST
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-7416
Country	:	US
Telephone Number	:	817-791-6426
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	04/10/2024

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Directions to “ MARISSA CRAHAN ” Practice Location

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