Provider Demographics
NPI:1649020298
Name:CRAWFORD, HOLLY REBECCA (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:REBECCA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3227 NORTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2678
Mailing Address - Country:US
Mailing Address - Phone:936-615-2474
Mailing Address - Fax:
Practice Address - Street 1:3227 NORTH ST STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2678
Practice Address - Country:US
Practice Address - Phone:936-615-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier