Provider Demographics
NPI:1053776062
Name:CROCKER, CAROL-ANN M (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROL-ANN
Middle Name:M
Last Name:CROCKER
Suffix:
Gender:F
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 1:31 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1141
Mailing Address - Country:US
Mailing Address - Phone:207-951-0995
Mailing Address - Fax:
Practice Address - Street 1:31 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1141
Practice Address - Country:US
Practice Address - Phone:207-951-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist