Provider Demographics
NPI:1205252210
Name:CRISP, SHAUN (COTA/L BS)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:CRISP
Suffix:
Gender:M
Credentials:COTA/L BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E 1ST AVE
Mailing Address - Street 2:STE 406
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2185
Mailing Address - Country:US
Mailing Address - Phone:614-208-6357
Mailing Address - Fax:
Practice Address - Street 1:601 OHIO 664
Practice Address - Street 2:HOCKING VALLEY COMMUNITY HOSPITAL
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138
Practice Address - Country:US
Practice Address - Phone:740-380-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05326224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant