Provider Demographics
NPI:1538667761
Name:CROWELL, CALEB (ATC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:CROWELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HINMAN BOX 6083
Mailing Address - Street 2:DARTMOUTH COLLEGE
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755
Mailing Address - Country:US
Mailing Address - Phone:603-646-9772
Mailing Address - Fax:
Practice Address - Street 1:FLOREN VARSITY HOUSE ATHLETIC TRAINING ROOM 111
Practice Address - Street 2:DARTMOUTH COLLEGE
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755
Practice Address - Country:US
Practice Address - Phone:603-646-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer