Provider Demographics
NPI:1639753346
Name:CRAYTON, TIMEESHA (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TIMEESHA
Middle Name:
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 ROAD 1023
Mailing Address - Street 2:
Mailing Address - City:PLANTERSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38862-7619
Mailing Address - Country:US
Mailing Address - Phone:662-322-4475
Mailing Address - Fax:
Practice Address - Street 1:343 ROAD 1023
Practice Address - Street 2:
Practice Address - City:PLANTERSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38862-7619
Practice Address - Country:US
Practice Address - Phone:662-322-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3812224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant