Provider Demographics
NPI:1083614077
Name:CRAIG, DANIEL D (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:D
Last Name:CRAIG
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 RAMSEY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5808
Mailing Address - Country:US
Mailing Address - Phone:541-476-1919
Mailing Address - Fax:541-476-1920
Practice Address - Street 1:497 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5681
Practice Address - Country:US
Practice Address - Phone:541-476-1919
Practice Address - Fax:541-476-1920
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR996284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPOO128179OtherMEDICARE RAILROAD
OR158775Medicaid
ORJ284209OtherPACIFIC SOURCE INSURANCE
ORR116914Medicare PIN