Provider Demographics
NPI:1396905618
Name:CRISP, MICHAEL D (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:CRISP
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 DEXTER AVE N
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1914
Mailing Address - Country:US
Mailing Address - Phone:206-284-7012
Mailing Address - Fax:
Practice Address - Street 1:2717 DEXTER AVE N
Practice Address - Street 2:QAHC: REHAB DEPARTMENT
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1914
Practice Address - Country:US
Practice Address - Phone:206-284-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003965225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist