Provider Demographics
NPI:1720219892
Name:CROLL, JEAN A (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:CROLL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-0087
Mailing Address - Country:US
Mailing Address - Phone:508-560-4007
Mailing Address - Fax:508-520-4895
Practice Address - Street 1:52 NOON HILL AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1161
Practice Address - Country:US
Practice Address - Phone:508-560-4007
Practice Address - Fax:508-520-4895
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA879225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics