Provider Demographics
NPI:1780281220
Name:CRAIG, JOANNA MAY (PT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MAY
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1120
Mailing Address - Country:US
Mailing Address - Phone:419-634-8655
Mailing Address - Fax:419-634-0402
Practice Address - Street 1:118 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1120
Practice Address - Country:US
Practice Address - Phone:419-634-8655
Practice Address - Fax:419-634-0402
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT008024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH218735Medicaid