Provider Demographics
NPI:1073121190
Name:DUNFORD, CRAIG (OT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:DUNFORD
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 RUGBY PIKE
Mailing Address - Street 2:
Mailing Address - City:ALLARDT
Mailing Address - State:TN
Mailing Address - Zip Code:38504-5014
Mailing Address - Country:US
Mailing Address - Phone:931-397-6149
Mailing Address - Fax:
Practice Address - Street 1:370 S LOWE AVE STE A330
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4730
Practice Address - Country:US
Practice Address - Phone:606-224-6915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000005119225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist