Provider Demographics
NPI:1528397064
Name:CRISCELLA, STEVEN DANIEL (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DANIEL
Last Name:CRISCELLA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 NW 53RD CT
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7718
Mailing Address - Country:US
Mailing Address - Phone:954-822-3149
Mailing Address - Fax:
Practice Address - Street 1:9330 NW 53RD CT
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7718
Practice Address - Country:US
Practice Address - Phone:954-822-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11406172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker