Provider Demographics
NPI:1598977530
Name:MCCRACKEN, SUSAN CALDWELL (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CALDWELL
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3162 SILVER LEAF DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2852
Mailing Address - Country:US
Mailing Address - Phone:970-412-1563
Mailing Address - Fax:
Practice Address - Street 1:1931 BOISE AVE STE 1
Practice Address - Street 2:CENTER FOR ADVANCED BODYWORK
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4295
Practice Address - Country:US
Practice Address - Phone:970-412-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONBCOT AA429001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95355332Medicaid