Provider Demographics
NPI:1295814242
Name:CRAIG, JEANNIE ELLEN (OT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:ELLEN
Last Name:CRAIG
Suffix:
Gender:F
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:PO BOX 612260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161-2260
Mailing Address - Country:US
Mailing Address - Phone:877-325-2776
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:2255 YGNACIO VALLEY RD STE E
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3349
Practice Address - Country:US
Practice Address - Phone:925-947-6666
Practice Address - Fax:925-935-6714
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 4346225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics