Provider Demographics
NPI:1588210348
Name:CROSLEY, CLAYTON BAKEWELL
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:BAKEWELL
Last Name:CROSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 SUNCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2210
Mailing Address - Country:US
Mailing Address - Phone:912-220-0373
Mailing Address - Fax:
Practice Address - Street 1:258 SUNCREST BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2210
Practice Address - Country:US
Practice Address - Phone:912-220-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No171400000XOther Service ProvidersHealth & Wellness Coach
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist