Active NPI
Annette Mock Crenshaw
- Pediatric Occupational Therapist
- Woodstock, GA
National Provider Identifier
1700118353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Occupational Therapist
- Practice address
- 215 Jep Wheeler Rd
Woodstock, GA 30188-6501 - Phone
- (678) 923-1088
- NPI assigned
- Feb 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | Primary |
Addresses
Primary practice location
215 Jep Wheeler Rd
Woodstock, GA 30188-6501
Mailing address
215 Jep Wheeler Rd
Woodstock, GA 30188-6501
Phone (678) 923-1088
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 720022501A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manely Kids | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265587200000",
"number": "1700118353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 JEP WHEELER RD",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301886501",
"telephone_number": "678-923-1088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 JEP WHEELER RD",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301886501",
"telephone_number": "678-923-1088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRENSHAW",
"first_name": "ANNETTE",
"middle_name": "MOCK",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-08",
"last_updated": "2010-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "720022501A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.