Basic Information
| Provider Information | |||||||||
| NPI: | 1760416374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWE | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 04/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 687 | ND | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE1200X | 687 | ND | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | 225XH1200X | 687 | ND | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 18210 | 01 | ND | NDBS # | OTHER | HP33434 | 01 | ND | HEALTHPARTNERS # | OTHER | 51602 | 05 | ND | MEDICAID | 60G80CR | 01 | ND | MNBS # | OTHER | DA9011015523 | 01 | ND | PREFERRED ONE # | OTHER | 21954 | 01 | ND | NDBS # | OTHER | 974267 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 6401675 | 01 | ND | MEDICA # | OTHER | 6402287 | 01 | ND | MEDICA # | OTHER | 70D29CR | 01 | ND | MNBS # | OTHER | 6403824 | 01 | ND | MEDICA # | OTHER |