Individual
MRS. JENNIFER ELAINE CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
2225 OLD EMMORTON ROAD, SUITE 210, BEL AIR, MD 21015-6123
(410) 515-4900
(410) 515-0777
Mailing address
115 GRACE MANOR DRIVE, HAVRE DE GRACE, MD 21078
(410) 939-1655
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
02900
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62041301
CAREFIRST BCBS
MD
Enumeration date
03/02/2007
Last updated
07/08/2007
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