Provider Demographics
NPI:1497325989
Name:CRAIN, JEFFREY (OT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:CRAIN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FALCON CREST DR
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3252
Mailing Address - Country:US
Mailing Address - Phone:605-491-2832
Mailing Address - Fax:605-988-6648
Practice Address - Street 1:1930 E 12TH ST APT 106
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4077
Practice Address - Country:US
Practice Address - Phone:307-554-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist