Provider Demographics
NPI:1881828663
Name:CRAFFORD, ALIDA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ALIDA
Middle Name:
Last Name:CRAFFORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1327
Mailing Address - Country:US
Mailing Address - Phone:765-438-7102
Mailing Address - Fax:
Practice Address - Street 1:610 MEADOW LN
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1327
Practice Address - Country:US
Practice Address - Phone:765-438-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001293A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist