Provider Demographics
NPI:1881815793
Name:JORDAN, CRAIG MICHAEL
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 PALMER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-5103
Mailing Address - Country:US
Mailing Address - Phone:508-540-5559
Mailing Address - Fax:508-540-5660
Practice Address - Street 1:620 PALMER AVE STE 2
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5103
Practice Address - Country:US
Practice Address - Phone:508-540-5559
Practice Address - Fax:508-540-5660
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004127225X00000X
NH1839225XH1200X
MA13357225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8902680OtherMEDICARE