Provider Demographics
NPI:1356892749
Name:CRANDALL, JENNIFER (OTD, OTR/L, CBIS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:OTD, OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 N ALMA SCHOOL RD
Mailing Address - Street 2:UNIT 10
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-1920
Mailing Address - Country:US
Mailing Address - Phone:480-215-4122
Mailing Address - Fax:
Practice Address - Street 1:1229 N ALMA SCHOOL RD
Practice Address - Street 2:UNIT 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-1920
Practice Address - Country:US
Practice Address - Phone:480-215-4122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist