Individual
MEGAN C CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 ILLINOIS AVE, STEVENS POINT, WI 54481-3114
(715) 346-5190
Mailing address
900 ILLINOIS AVE, STEVENS POINT, WI 54481-3114
(715) 346-5190
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5732-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5732-26
WI STATE LIC
WI
Enumeration date
08/23/2016
Last updated
08/23/2016
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