Provider Demographics
NPI:1982661377
Name:CRABB, GRETCHEN ANN-BECKER (MSE, OTR/L, LPC-IT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANN-BECKER
Last Name:CRABB
Suffix:
Gender:F
Credentials:MSE, OTR/L, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 ODANA RD STE 11
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1177
Mailing Address - Country:US
Mailing Address - Phone:608-424-8006
Mailing Address - Fax:
Practice Address - Street 1:6409 ODANA RD STE 11
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1177
Practice Address - Country:US
Practice Address - Phone:608-424-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3697-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty