Provider Demographics
NPI:1457724700
Name:CRAGGS, WILLIAM (CPO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CRAGGS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2310
Mailing Address - Country:US
Mailing Address - Phone:708-848-4646
Mailing Address - Fax:708-848-1341
Practice Address - Street 1:214 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2310
Practice Address - Country:US
Practice Address - Phone:708-848-4646
Practice Address - Fax:708-848-1341
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000141222Z00000X
IL211.000099224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist