Individual
MRS. SUSAN MARIE LACROIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
638 N BROAD ST, ELKHORN, WI 53121-1104
(262) 723-4963
Mailing address
W1267 N BLUE SPRING LAKE DR, PALMYRA, WI 53156-9226
(262) 495-4857
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
220-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40675000
—
WI
Enumeration date
04/18/2007
Last updated
07/09/2007
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