Individual
MRS. DIANE MARIE CRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
111 FAIRGROUND RD, GLENVILLE, WV 26351-1388
(304) 462-5718
Mailing address
111 FAIRGROUND RD, GLENVILLE, WV 26351-1388
(304) 462-5718
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2094
WV
Other
Enumeration date
01/28/2021
Last updated
01/28/2021
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