Provider Demographics
NPI:1598453201
Name:SKORICH, CRAIG (OTR/L, CAPS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SKORICH
Suffix:
Gender:M
Credentials:OTR/L, CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 BRANTLEY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1822
Mailing Address - Country:US
Mailing Address - Phone:904-315-1782
Mailing Address - Fax:
Practice Address - Street 1:292 BRANTLEY HARBOR DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1822
Practice Address - Country:US
Practice Address - Phone:904-315-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist