Provider Demographics
NPI:1538523543
Name:CRAWLEY, CHAWN WARREN (LMT)
Entity type:Individual
Prefix:MR
First Name:CHAWN
Middle Name:WARREN
Last Name:CRAWLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W UTICA ST
Mailing Address - Street 2:SUITE CC
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3031
Mailing Address - Country:US
Mailing Address - Phone:315-806-7587
Mailing Address - Fax:
Practice Address - Street 1:104 W UTICA ST
Practice Address - Street 2:SUITE CC
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3031
Practice Address - Country:US
Practice Address - Phone:315-806-7587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029512-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist