Provider Demographics
NPI:1558769125
Name:KROLL, DAVID (MAED, ATC/L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:KROLL
Suffix:
Gender:M
Credentials:MAED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 LAMBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2824
Mailing Address - Country:US
Mailing Address - Phone:715-919-1816
Mailing Address - Fax:715-395-4636
Practice Address - Street 1:BALKNAP & CATLIN AVES.
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880
Practice Address - Country:US
Practice Address - Phone:715-394-8144
Practice Address - Fax:715-395-4643
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI486-39174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist