Provider Demographics
NPI:1689357402
Name:CRAWFORD, MARYKATE NOELLE (OTD)
Entity Type:Individual
Prefix:
First Name:MARYKATE
Middle Name:NOELLE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3431
Mailing Address - Country:US
Mailing Address - Phone:202-546-4477
Mailing Address - Fax:
Practice Address - Street 1:820 26TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3262
Practice Address - Country:US
Practice Address - Phone:202-388-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT210002226225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist