Daniel A Crockett, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

0000001524 Issued in TN

Practice address

640 Hannings LN
Martin, TN 38237-3308

Phone

(731) 587-3193

Fax

(731) 588-2732

NPI assigned

May 10, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073727871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 SUNSET DR",
            "city": "MADISONVILLE",
            "state": "KY",
            "postal_code": "424311841",
            "telephone_number": "270-339-0355",
            "fax_number": "731-588-2732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HANNINGS LN",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373308",
            "telephone_number": "731-587-3193",
            "fax_number": "731-588-2732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "DANIEL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TN",
            "license": "0000001524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapy Assistant in Martin, TN
• Providers in Martin, TN by specialty
• Occupational Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.