MEDICARE: MR. DAN WILLIAM CROUCH MOT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2001015288	MO

General Provider Information

NPI Number	:	1730145467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN WILLIAM CROUCH MOT

Provider Business Mailing Address
First Line	:	412 W 8TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64105-2273
Country	:	US
Telephone Number	:	816-221-4618
Fax Number	:

Provider Business Practice Location Address
First Line	:	11228 MILITARY CLUB RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3621
Country	:	US
Telephone Number	:	816-358-8614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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