Provider Demographics
NPI:1285831115
Name:CRUM, TERESA (OTRL)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 SHOPES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8494
Mailing Address - Country:US
Mailing Address - Phone:606-928-7731
Mailing Address - Fax:
Practice Address - Street 1:6900 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2000
Practice Address - Country:US
Practice Address - Phone:304-733-1060
Practice Address - Fax:304-733-9284
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRPT429225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist