Provider Demographics
NPI:1417461310
Name:CRESCENTI, LAURA C
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:C
Last Name:CRESCENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GOLDEN BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-9025
Mailing Address - Country:US
Mailing Address - Phone:215-290-2385
Mailing Address - Fax:
Practice Address - Street 1:190 RIVER PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6844
Practice Address - Country:US
Practice Address - Phone:215-290-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015360225X00000X
SC5836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist