Provider Demographics
NPI:1912035692
Name:CRAWFORD, CARLENE MCCOMB (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:MCCOMB
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 S 283RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-8573
Mailing Address - Country:US
Mailing Address - Phone:918-357-9277
Mailing Address - Fax:918-357-9277
Practice Address - Street 1:5900 S 283RD EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-8573
Practice Address - Country:US
Practice Address - Phone:918-357-9277
Practice Address - Fax:918-357-9277
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK183225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist