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General NPI Number Information
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NPI Number | 1992199137
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Entity Type | Individual
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Provider Name | COURTNEY C CROUSE OTR
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Gender | Female
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 1601 LAWRENCE DR STE 100
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City | DE PERE
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State | WI
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Zip | 54115-3931
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 118462
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5633-26
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License Number State | WI
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