Provider Demographics
NPI:1124547286
Name:CRAWFORD, AMELIA (LMT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 EUREKA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3622
Mailing Address - Country:US
Mailing Address - Phone:907-414-2786
Mailing Address - Fax:
Practice Address - Street 1:376 LAYLA CT
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1441
Practice Address - Country:US
Practice Address - Phone:907-456-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
AK102045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist