Provider Demographics
NPI:1881368314
Name:CRANE, JUSTEN BLARE (OT)
Entity type:Individual
Prefix:
First Name:JUSTEN
Middle Name:BLARE
Last Name:CRANE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S GRAND MERE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-6428
Mailing Address - Country:US
Mailing Address - Phone:316-304-8786
Mailing Address - Fax:
Practice Address - Street 1:10665 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5600
Practice Address - Country:US
Practice Address - Phone:316-285-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-05645225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist