Healthcare Provider Details

I. General information

NPI: 1801707369
Provider Name (Legal Business Name): ZACHARY SKROVE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRING ST
MOUNT PLEASANT WI
53405-1667
US

IV. Provider business mailing address

380 WOODS EDGE DR
MUKWONAGO WI
53149-5635
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: