Provider Demographics
NPI:1689765802
Name:HANUS-KROLL, ELIZABETH A (OTR)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:HANUS-KROLL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:HANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3126 N 104 ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-257-3937
Mailing Address - Fax:414-570-0442
Practice Address - Street 1:8825 S HOWELL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:414-570-0441
Practice Address - Fax:414-570-0442
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1426-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41814100Medicaid
WI526590Medicare ID - Type Unspecified