Provider Demographics
NPI:1114680550
Name:SHIVE, CRISSEN L (MOT)
Entity Type:Individual
Prefix:MRS
First Name:CRISSEN
Middle Name:L
Last Name:SHIVE
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17004 WOODVIEW CV
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6071
Mailing Address - Country:US
Mailing Address - Phone:601-506-8240
Mailing Address - Fax:
Practice Address - Street 1:17004 WOODVIEW CV
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6071
Practice Address - Country:US
Practice Address - Phone:601-506-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist