Provider Demographics
NPI:1689349599
Name:CROOK, DUWAYNE JOHN (OTR)
Entity Type:Individual
Prefix:
First Name:DUWAYNE
Middle Name:JOHN
Last Name:CROOK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 N SPRING GULCH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9307
Mailing Address - Country:US
Mailing Address - Phone:520-393-9069
Mailing Address - Fax:
Practice Address - Street 1:8000 N SPRING GULCH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9307
Practice Address - Country:US
Practice Address - Phone:520-393-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist