Provider Demographics
NPI:1790994119
Name:SUMMERS, CRAIG L (MT-BC)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:L
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 QUEENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-6930
Mailing Address - Country:US
Mailing Address - Phone:828-246-2534
Mailing Address - Fax:
Practice Address - Street 1:560 LEROY GEORGE DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-7408
Practice Address - Country:US
Practice Address - Phone:828-246-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist