Individual
MEGAN C CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
626 E SLIFER ST, PORTAGE, WI 53901-1224
(608) 745-5400
Mailing address
4429 MEADOW LN, AMHERST, WI 54406-9117
(805) 455-6455
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
05/21/2026
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