Provider Demographics
NPI:1508311705
Name:CREWS, TRACEY LEIGH (MS, OTR)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LEIGH
Last Name:CREWS
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BOULEVARD
Mailing Address - Street 2:SUITE 3070
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:317-449-4833
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:4422 EAST STATE BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-6917
Practice Address - Country:US
Practice Address - Phone:885-324-0885
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014885225XP0200X
MI5201005313225XP0200X
IN31006496A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015036OtherNBCOT CERTIFICATION