Provider Demographics
NPI:1730145467
Name:CROUCH, DAN WILLIAM (MOT)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:WILLIAM
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2273
Mailing Address - Country:US
Mailing Address - Phone:816-221-4618
Mailing Address - Fax:
Practice Address - Street 1:11228 MILITARY CLUB RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-3621
Practice Address - Country:US
Practice Address - Phone:816-358-8614
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015288225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist