Provider Demographics
NPI:1003203985
Name:VAN CREVELD, SASCHA ILANA (OT)
Entity Type:Individual
Prefix:MS
First Name:SASCHA
Middle Name:ILANA
Last Name:VAN CREVELD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2470
Mailing Address - Country:US
Mailing Address - Phone:203-376-9085
Mailing Address - Fax:
Practice Address - Street 1:345 STEVENSON RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2470
Practice Address - Country:US
Practice Address - Phone:203-376-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001052172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker